Symptoms of Polymyalgia Rheumatica
• Stiffness and pain are usually severe but subacute or insidious in onset (2–3 months) and involve more than one area (neck, shoulders, pelvic girdle) symmetrically. However, at times, the onset may be sudden and the initial symptoms may start unilaterally and then progress to symmetric involvement within a few weeks.
• The shoulder is the first area affected in 70% to 95% of the patients. The neck and pelvic girdle are involved in 50% to 70% of cases. A single area may be the predominant source of pain.
• The pain and stiffness lasts several hours, limiting the patient’s mobility. Gelling phenomenon and nocturnal pain are common and the pain may awaken the patient.
• Patients may perceive that they have muscle weakness in addition to the pain and stiffness. However, this actually represents guarding instead of neuromuscular dysfunction which can be proven by careful neurologic exam.
Up to 33% of patients have constitutional symptoms/signs and appear chronically ill with anorexia, weight loss, night sweats, fatigue, depression, and low-grade fever. High, spiking fevers are unusual unless GCA is present.
