How can you differentiate polymyalgia rheumatica other diseases?

Written by: Dra. Eulalia Gil González
Edited by: Ester Izquierdo Romagosa

Polymyalgia rheumatic (PMR) is an inflammatory disease whose main characteristic pain and stiffness in the waist, shoulders, hips and neck. Although it is related to other pathologies or present similar symptoms, it is important that both the patient and the rheumatologist know the differences.

Giant cell arteritis and Polymyalgia Rheumatic

Symptoms of giant cell arteritis (GCA), such as headache, sensitivity of the temporal artery, jaw pain, evidence of cerebral ischemia or loss of vision, not often occur in PMR. If so, it is important that the rheumatologist make continuous monitoring of these symptoms.


Polymyalgia Rheumatic arthritis and Reumatolide

Patients with arthritis Reumatolide (AR) tend to have symmetric polyarthritis in the small joints of the hands and feet, which is persistent and partially responds to low doses of prednisone, a corticosteroid drug. These symptoms are different from the PMR, in which there are not many inflamed joints and normally responds to low doses of prednisone.


RS3PE syndrome and Polymyalgia Rheumatic

RS3PE symptoms syndrome (seronegative symmetrical synovitis with pitting edema sender) can be easily confused with PMR. The main features of RS3PE syndrome that differentiate it from the PMR are:


  • sudden onset of polyarthritis
  • It affects more older than 50 years old
  • Lack rheumatoid factor (abnormal on the globulin serum)
  • Symptoms are usually more prominent distally
  • Some patients respond to treatment with low doses of glucocorticoids
  • It may be considered a variant of edema PMR


Spondyloarthropathy and Polymyalgia Rheumatic

In the espondilartropatía (SpA) late onset constitutional symptoms may appear, such as fever, weight loss and anorexia, along with an elevated erythrocyte sedimentation rate (rate at which red blood cells "fall"). But other symptoms that are not normally in the PMR, such as inflammation of muscles, ligaments, fingers and toes, the sacroiliac joints (where the lumbar spine connects with the pelvis), and a higher prevalence also appear HLA-B27 positive.


Hypothyroidism and Polymyalgia Rheumatic

Patients with hypothyroidism may experience pain and stiffness in the joints, but the differential factor is the alteration of thyroid hormones, which would give the diagnosis.


Rheumatic Fibromyalgia and Polymyalgia

Although it may present clinically similarly, patients with fibromyalgia have an erythrocyte sedimentation rate, hematocrit and normal protein C, unlike the PMR.


Tendinitis, Bursitis and Polymyalgia Rheumatic

Symptoms shoulders with PMR may be similar to those of the subdeltoid bursitis (under the deltoid, shoulder muscle that is responsible for raising the arm) or tendinitis of the rotator cuff (muscles that give stability to the shoulder). However, unlike PMR, patients with tendinitis or bursitis have no constitutional symptoms, ie, weight loss, fatigue and anorexia. Nor have an elevated erythrocyte sedimentation rate and anemia.


Malignancies and Polymyalgia Rheumatic

There is no relationship between the appearance of the PMR and malignant tumors. However, some cancer patients may have pain in the muscles and similar to those of the PMR joints, but in this case do not respond to prednisone.


And Polymyalgia Rheumatic Infective Endocarditis

This and other infectious diseases can be confused with PMR, but symptoms that differentiate endocarditis PMR are heart murmurs, persistent fever, adenoids in a heart valve (formation of clumps of tissue within the heart) and positive blood cultures .


Polymyalgia Rheumatic inflammatory myopathy

Muscle diseases such as polymyositis or dermatomyositis usually present with symmetrical proximal muscle weakness, but the pain is not as intense as in PMR. Other distinguishing factors are abnormal electromyography, elevated levels of muscle enzymes or evidence of myositis on muscle biopsy.

*Translated with Google translator. We apologize for any imperfection

By Dra. Eulalia Gil González

Dr. Gil Gonzalez is a renowned specialist in rheumatology expert in the treatment of arthritis, osteoarthritis, fibromyalgia, among other conditions. In addition, it is also a specialist in clinical analysis and a master's degree in Dietetics and Nutrition. During his long career he has been general practitioner and work in several centers in Seville, including the Ministry of Health and Social Services of Andalusia, besides specialist in rheumatology and Analysis Cynics in the provinces of Seville and Cadiz. He has also participated in numerous conferences with papers and communications, in addition to having published numerous book chapters and journal articles specialty. Currently, she combines her work as a rheumatologist in the Guadaira Medical Center in Alcalá de Guadaira (Sevilla), which is the principal, the Chiron Sevilla Hospital and the Clinica Santa Isabel de Sevilla, with research in research projects Clinical Management Unit of Rheumatology, University Hospital Virgen Macarena in Seville.

*Translated with Google translator. We apologize for any imperfection

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