Over this past week, I had the pleasure of meeting an elderly gentleman who had recently been diagnosed with polymyalgia rheumatica (PMR).  He proceeded to tell me about his initial symptoms which were textbook including shoulder stiffness and pain in the pelvic girdle.  He also stated that he had terrible time getting out of bed.  This clinical course along with an elevated ESR and CRP nailed his diagnosis.  Upon further discussion with my preceptor, he said that this diagnosis is not uncommon.  This patient's pain was controlled at this time but he wanted to know about future prediction of his pain status and his overall quality of life.  I did some research to see if there were any predictors for disease progression/prognosis.  I found this article from Italy which discusses some lab values that could be of use.  They determined through their prospective followup study, that persistently elevated levels of CRP and IL-6 were associated with an increased rate of relapse/recurrence of the disease.  They concluded that the standadrd therapy of corticosteroids is not enough to prevent the inflammatory process in this group of patients with persistently elevated levels of CRCP and IL-6.  Based on this, it ay be possible to test these levels in patients and have some idea as to which patient has a higher likelihood of relapse. 

Also of note on this topic, there is an increased association with temporal arteritis which can cause eventual blindness.  PMR is typically treated with prednisone 20 mg daily for one month, then there is a taper.  This is continued for one year. 

 I think that this is an important diagnosis to consider when dealing with patients with arthritis tye complaints.  The presentation is very classical in most patients and Dx can be made with ESR and CRP.  This is treatable with predinisone in most so it is important to differentiate b/w osteoarthritis in these patients because of differing treatments.