Easy Level - Polymyalgia Rheumatica (PMR) Clinical Review

Comprehensive vocabulary flashcards covering the pathophysiology, diagnosis, unmet needs, current therapies, and emerging clinical trials for Polymyalgia Rheumatica (PMR).

Polymyalgia Rheumatica (PMR) age of onset

PMR characteristically affects adults over the age of $50$ and is very rare before that age.

PMR symptoms: Body distribution

PMR classically causes bilateral pain and stiffness in the shoulder and hip (pelvic) girdles.

PMR gender prevalence

The condition is about $2-3$ times more common in women than in men.

PMR Morning stiffness

A classic feature and classification criterion that typically lasts more than $45$ minutes.

Interleukin-6 (IL-6)

The central inflammatory cytokine and key driver of inflammation in PMR that is the target of newer therapies.

PMR Symptom Onset

Characteristically rapid, typically occurring over a period of about a day to $2$ weeks.

PMR highest risk population

PMR occurs most frequently in people of Northern European and Scandinavian backgrounds.

PMR Muscle Enzyme (CK) levels

Contrary to true muscle weakness conditions, muscle enzymes (creatine kinase) are normal in patients with PMR.

Giant cell arteritis (GCA)

An inflammatory condition closely related to PMR; both are part of the same disease spectrum and often overlap.

PMR Inflammatory Markers

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are typically elevated in active disease.

Rheumatoid factor (RF) and anti-CCP in PMR

These blood tests are typically negative; they are primarily checked to help rule out rheumatoid arthritis.

GCA Red Flag symptoms

New onset headache, vision changes, or jaw pain on chewing in a PMR patient.

Steroid response as diagnostic support

A rapid improvement in symptoms, often within $24-72$ hours of starting low-dose steroids (prednisone), supports a diagnosis of PMR.

Shoulder Ultrasound in PMR

An imaging test that can show subdeltoid bursitis, biceps tenosynovitis, and glenohumeral synovitis.

Fibromyalgia

A common mimic of PMR that presents with widespread pain but features normal inflammatory markers and a poor response to steroids.

Prednisone first-line dosing

The recommended starting range for PMR is typically $12.5-25$ $mg/day$, commonly around $15$ $mg/day$.

Glucocorticoid dependence

A major unmet need in PMR treatment where roughly $77$% of patients remain on steroids at one year and about half at two years.

Long-term steroid side effects

Includes osteoporosis, fractures, diabetes, high blood pressure, cataracts, weight gain, and increased infection risk.

Steroid-sparing effect

Achieving disease control while reducing the total amount of steroid exposure and toxicity for the patient.

Sarilumab (Kevzara)

The first and only biologic drug FDA-indicated specifically for PMR, approved in $2023$, which acts as an IL-6 receptor blocker.

Methotrexate

An older medication sometimes added to treatment as a steroid-sparing option, particularly in patients at high risk of relapse.

SAPHYR clinical trial

The phase $3$ clinical trial that tested Sarilumab and supported its FDA approval for the treatment of PMR.

Secukinumab

An IL-$17$ inhibitor that met its endpoints in the REPLENISH phase $3$ trial in $2026$, showing positive results for PMR.

Upadacitinib

The first oral JAK inhibitor FDA-approved for the treatment of giant cell arteritis in $2025$.

Tocilizumab

An IL-$6$ inhibitor FDA-approved for giant cell arteritis in $2017$ and used off-label to treat PMR.