Definitions

PMR is a clinical syndrome whose cause is unknown. There is no universally accepted definition, but several classification criteria include patients over the age of 50 years, who have moderate-to-severe aching and stiffness of the neck, torso, shoulders, or proximal regions of the arms, hips, or thighs, of at least one-month duration, with morning stiffness and elevated markers of systemic inflammation such as erythrocyte sedimentation rate (ESR) (3).

PMR often occurs in association with GCA (temporal) and may be the initial clinical feature of GCA. About 50% of patients with GCA have PMR, and between 10% and 40% of patients with PMR have GCA as the underlying disease. GCA is a chronic vasculitis of medium and large arteries. Although a systemic disease, symptomatic arterial inflammation most typically involves the cranial branches of the arteries having their origin at the aortic arch, leading to its characteristic head and neck disease features. The American College of Rheumatology criteria for the classification of GCA separate it from other primary vasculitides on the basis of five essential features (4). These are age at onset of greater than 50 years, new onset of head pain, abnormality of the temporal artery with tenderness to palpation or decreased pulse not related to atherosclerosis, elevation of the ESR (generally greater than 50 mm in the first hour by Westergren method), and abnormal findings of vasculitis on biopsy of the temporal artery.

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