Conditions mimicking polymyalgia rheumatica identified
Understanding Polymyalgia Rheumatica (PMR) and Its Differences from Other Conditions
Polymyalgia Rheumatica (PMR) is a condition that affects individuals over the age of 50, causing widespread aching and stiffness in the joints, particularly in the upper arms and shoulders, neck, hips, lower back, thighs [1][5][3]. The condition is characterised by bilateral pain and stiffness in the shoulders and hip girdles, morning stiffness lasting more than 30 minutes, neck pain, fatigue, and systemic inflammation [3][5][1].
PMR shares some symptoms with other conditions, such as Rheumatoid Arthritis (RA), fibromyalgia, Lyme disease, lupus, vasculitis, and cancer. However, it is essential to understand the key differences between PMR and these conditions to ensure accurate diagnosis and appropriate treatment.
PMR vs. Rheumatoid Arthritis (RA)
Both PMR and RA can cause joint pain and stiffness, but RA primarily affects smaller joints (hands, wrists), and the stiffness often lasts for more than an hour. RA involves true joint inflammation and erosions, whereas PMR affects proximal muscles and larger limb girdles [4]. Additionally, RA may have positive rheumatoid factor and anti-CCP antibodies, while inflammatory markers in PMR are elevated but follow a different pattern [4].
PMR vs. Systemic Lupus Erythematosus (Lupus)
Lupus presents with systemic autoimmune features not typical in PMR, such as a rash over the nose and cheeks, mouth sores, and kidney involvement. Inflammation in lupus can be widespread, and lab tests show ANA positivity and other autoantibodies [4].
PMR vs. Fibromyalgia
Fibromyalgia lacks inflammation and presents with chronic, widespread pain, fatigue, sleep disturbances, and cognitive complaints. The condition does not cause joint swelling, and lab tests are usually normal [2].
PMR vs. Lyme Disease
Exposure to ticks and the presence of a rash (often resembling a bull's-eye) are common in Lyme disease, which can cause joint pain and stiffness, fever, and fatigue, much like PMR. However, arthritis in Lyme disease is usually mono- or oligoarticular, and inflammation markers can vary [4].
PMR vs. Cancer
Cancer may mimic PMR, causing weight loss, night sweats, fever, and localized or systemic pain. However, cancer involves systemic constitutional signs, and imaging and biopsy can reveal malignancy [1][4].
Diagnosis and Treatment
Diagnosing PMR requires clinical evaluation, lab tests, imaging, and sometimes biopsy to exclude mimics and confirm the condition [1][3][4]. Blood tests may be used to rule out other conditions, such as lupus and RA, by measuring a complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), and antinuclear antibody (ANA).
There is no single test for PMR, and diagnosis can be challenging. Doctors will begin by asking about symptoms, taking a medical history, and conducting a physical examination of the affected joints. If a person could have giant cell arteritis, the doctor may also examine arteries to see if they are inflamed or tender or have a reduced pulse. An ultrasound or MRI scan may also be used to check for bursitis.
Early treatment can make PMR, as well as other similar conditions, easier to manage. If you suspect you may have PMR or any of the conditions mentioned above, it is essential to speak with a doctor, especially if you have had a recent tick bite or show signs of giant cell arteritis.
References:
[1] National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2020). Polymyalgia Rheumatica. Retrieved from https://www.niams.nih.gov/health-topics/polymyalgia-rheumatica
[2] American College of Rheumatology. (2020). Fibromyalgia. Retrieved from https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia
[3] Mayo Clinic. (2020). Polymyalgia rheumatica. Retrieved from https://www.mayoclinic.org/diseases-conditions/polymyalgia-rheumatica/symptoms-causes/syc-20357097
[4] Rheumatology Advisor. (2020). Differentiating Polymyalgia Rheumatica from Other Conditions. Retrieved from https://www.rheumatologyadvisor.com/home/topics/rheumatoid-arthritis/differentiating-polymyalgia-rheumatica-from-other-conditions/
[5] Arthritis Research UK. (2020). Polymyalgia Rheumatica. Retrieved from https://www.arthritisresearchuk.org/arthritis-information/conditions/polymyalgia-rheumatica.aspx
- Polymyalgia Rheumatica (PMR) is an ongoing health concern for many individuals, with symptoms such as widespread aching and stiffness.
- These symptoms are particularly prominent in the upper arms and shoulders, neck, hips, lower back, and thighs.
- PMR is distinguished from other conditions by its bilateral pain and stiffness in the shoulders and hip girdles, morning stiffness, and systemic inflammation.
- Rheumatoid Arthritis (RA), a noteworthy condition to differentiate from PMR, affects smaller joints like hands and wrists.
- RA's stiffness usually lasts beyond an hour, and it involves true joint inflammation and joint erosions.
- In contrast, PMR impacts proximal muscles and larger limb girdles.
- Diagnostic tests like a complete blood count, C-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), and antinuclear antibody (ANA) can help rule out other conditions, such as lupus and RA.
- Systemic Lupus Erythematosus (Lupus) is characterized by systemic autoimmune features not typically found in PMR, such as a rash over the nose and cheeks, mouth sores, and kidney involvement.
- Fibromyalgia, another condition to differentiate from PMR, presents with chronic, widespread pain, fatigue, sleep disturbances, and cognitive complaints.
- Lyme Disease may share some symptoms with PMR, including joint pain and stiffness, fever, and fatigue. Still, it usually presents with mono- or oligoarticular arthritis, and inflammation markers can vary.
- Cancer represents a set of diseases that can mimic PMR, leading to weight loss, night sweats, fever, and localized or systemic pain.
- Cancer involves systemic constitutional signs, and imaging or biopsy can reveal malignancy.
- Atopic dermatitis, a form of skin inflammation, is one of the chronic diseases with autoimmune origins often requiring medical-conditions management.
- Multiple Sclerosis is a neurological disorder characterized by the immune system damaging the myelin sheath, causing communication problems between the brain and the rest of the body.
- Diabetes, another chronic disease, requires diligent management to maintain health and wellness, particularly when it comes to eye-health, digestive-health, and men's-health.
- Ankylosing Spondylitis, an autoimmune-disorder that primarily affects the spine, can be managed through fitness-and-exercise and therapies-and-treatments, helping to improve symptoms and prevent further progression.
- Pain from Sclerosis and psoriasis, skin-conditions, can often be alleviated with effective dermatitis treatment and skin-care regimens.
- Depression, a mental-health issue, is often comorbid with physical-health conditions like chronic-diseases, and it requires attention from both general practitioners and specialists.
- Workplace wellness programs often address conditions like obesity, HIV, and asthma, as these are common medical concerns in the workplace.
- CBD oil has been researched for its potential benefits in managing chronic pain, anxiety, and other mental-health issues, as well as conditions such as diabetes, digestive-health, and eye-health.
