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Polymyositis and Polymyalgia Rheumatica

Introduction of Polymyositis and Polymyalgia Rheumatica

The primary distinction that distinguishes polymyositis and polymyalgia Rheumatica can be seen in the fact that polymyositis is an inflammation muscle disorder where weakness or tenderness that affects muscles becomes more apparent and polymyalgia rheumatica, an inflammatory condition of the muscles that causes muscle stiffness or pain with no weakness is the most noticeable.

Polymyositis is a rare form of autoimmune myopathy characterized by muscle inflammation and weakness, typically affecting skeletal muscles, causing them to atrophy in symmetrical patterns. Diagnosis usually requires laboratory tests and muscle biopsy, and treatments typically consist of immunosuppressant medications and physical therapy sessions failure to manage polymyositis effectively can result in long-term disability as well as coexisting conditions like other autoimmune diseases.

Polymyalgia rheumatica (PMR), by contrast, is a more widespread inflammatory condition typically affecting individuals over 50 years old. PMR typically manifests itself in pain and stiffness in the shoulders and hip girdles along with systemic symptoms like fatigue and weight loss.

Diagnosis typically relies on elevated inflammatory markers as well as ruling out other possible conditions. Corticosteroid treatment tends to provide significant symptom relief, unlike polymyositis which often does not respond positively. Managing PMR well should result in a favorable prognosis when managed appropriately compared with polymyositis which tends not to respond as positively when managed accordingly.

What is Polymyositis?

Figure 01: Polymyositis

Polymyositis is a chronic and rare autoimmune inflammatory myopathy characterized by inflammation and weakening of skeletal muscles, particularly in areas nearer the trunk of the body such as hips, thighs, shoulders, and neck. This condition usually results from an abnormal immune response when our immune systems mistakenly attack healthy muscle tissue rather than protecting against foreign invaders like viruses.

Polymyositis’ exact causes remain unknown, although it’s thought to involve genetic, environmental, and immunological components. Most commonly occurring among adults aged 30-60 (with females having an increased likelihood), it usually affects adults between the ages of 30-60 years old with higher incidence among females.

Polymyositis’ characteristic symptoms are muscle weakness and pain, often compounded with fatigue. Over time, this weakness may progress gradually over weeks or months until daily tasks such as climbing stairs, getting out of a chair, and lifting objects become difficult or impossible to perform without assistance. Over time it can even cause atrophy (the gradual breakdown of muscle tissue).

Polymyositis can usually be diagnosed through a combination of clinical evaluation, blood tests to detect elevated muscle enzymes and autoantibodies, electromyography (EMG) to evaluate muscle electrical activity, and muscle biopsy to confirm the presence of inflammation.

Polymyositis treatment typically entails immunosuppressant drugs like corticosteroids or immune-modulating drugs to alleviate an overactive immune response. Physical therapy and exercise programs may help maintain muscle strength and function.

If unmanaged, polymyositis could result in long-term disability; early diagnosis and appropriate therapy can significantly enhance the quality of life and prognosis for patients close monitoring by healthcare professionals can ensure effective management and minimize potential complications.

Signs and Symptoms of Polymyositis

Signs and symptoms of polymyositis often include:

  • Muscle Weakness: Progressive and symmetric muscle weakness are characteristic symptoms of polymyositis. This often begins in proximal (closest to the trunk) muscles like those found in hips, thighs, shoulders, and neck regions.
  • Muscle Pain: Muscles affected by injuries may become painful, tender, or sore; this pain can range from mild to severe and become worse with movement or activity.
  • Muscle Atrophy: Over time, as muscles weaken they may begin to shrink or atrophy resulting in the loss of muscle mass and mass reduction.
  • Fatigue: Many individuals who suffer from polymyositis experience significant fatigue that may manifest physically as well as mentally.
  • Difficulties With Activities: Daily tasks such as standing up from a chair, climbing stairs, and lifting objects may become increasingly challenging due to muscle weakness.
  • Dysphagia: Swallowing difficulties (dysphagia) may occur if any of the muscles responsible for swallowing become impaired.
  • Respiratory Muscle Weakness: Polymyositis can lead to respiratory muscle weakness, leading to difficulty breathing.
  • Changes to Skin: Some individuals may notice skin changes such as red or purple rashes called Gotttron’s papules or “heliotrope rash” appearing on their eyelids.
  • Joint Pain: Although less frequently reported, polymyositis may cause joint discomfort.
  • Systemic Symptoms: Muscle-related symptoms, Some individuals may also experience systemic symptoms like fever, weight loss, and feeling of unwellness.

What is Polymyalgia?

Figure 02: Polymyalgia

Polymyalgia rheumatica (PMR) is an inflammatory condition most prevalent among older adults; typically those aged 50 or over. Its hallmark symptoms are muscle pain and stiffness in the shoulders, neck, and hip girdles as well as systemic symptoms like fatigue, weight loss, and low-grade fever.

PMR remains poorly understood experts suspect it has an autoimmune component wherein the body’s immune system attacks its own tissues mistakenly causing inflammation in affected muscles and surrounding tissues.

PMR symptoms typically include muscle aches and stiffness that is especially evident upon awakening or after periods of inactivity. These symptoms can severely restrict the range of motion and make performing everyday tasks such as getting out of bed or raising one’s arms difficult.

Diagnosing PMR often relies on clinical evaluation, blood tests showing elevated inflammatory markers such as ESR and CRP levels, and ruling out other possible conditions that can mimic its symptoms.

Prednisone may provide rapid relief of symptoms for individuals suffering from PMR. Initial doses should be high but can gradually be tapered down as symptoms improve; most individuals experiencing PMR experience significant symptom relief and can resume normal activities more quickly with proper management.

Long-term corticosteroid use may have side effects, and so it is best to find a dose with no potential for side effects that is optimal. Regular monitoring by healthcare providers is also vital in order to address potential issues resulting from treatment as well as any potential issues or related side effects caused by treatment.

Signs and Symptoms of Polymyalgia Rheumatica

Here are the symptoms and signs of PMR:

  • Muscle Pain: PMR’s hallmark symptoms are muscle ache and stiffness in the shoulders, neck, and hip girdles – typically bilaterally with severe intensity. This pain often has no apparent source.
  • Morning Stiffness: Morning stiffness or inactivity usually makes symptoms more evident, making it hard to get out of bed or perform daily activities.
  • Limited Range of Motion: Stagnant joints may become restricted due to stiffness or pain, making it more difficult for someone to lift their arms overhead or perform overhead activities such as dressing themselves.
  • Fatigue: People living with PMR often report feeling extreme fatigue and weakness that affects both their physical body as well as mental wellbeing.
  • Systemic Symptoms: Some patients may exhibit systemic symptoms such as low-grade fever, weight loss and sense of illness.
  • Symmetry: Most symptoms tend to be symmetric, meaning they affect both sides of the body equally.
  • Temporal Arteritis: PMR may sometimes be associated with temporal arteritis (also referred to as giant cell arteritis), an inflammation of the temporal arteries that can result in headaches, scalp tenderness and vision problems.
  • Depression: Chronic pain and limitations to daily activities may result in emotional distress and even depression.

Difference Between Polymyositis and Polymyalgia Rheumatica

Here’s a comparison chart highlighting the key differences between Polymyositis and Polymyalgia Rheumatica:

Characteristic Polymyositis Polymyalgia Rheumatica
Definition Rare autoimmune inflammatory myopathy Inflammatory disorder primarily affecting older adults
Age of Onset Typically 30 to 60 years old Typically age 50 and older
Affected Tissues Primarily skeletal muscles Predominantly shoulders, neck, and hip girdles
Clinical Features Muscle weakness, atrophy, and pain Muscle pain and stiffness, systemic symptoms like fatigue and weight loss
Etiology Autoimmune response targeting muscle tissue Autoimmune component, precise cause unclear
Diagnostic Tests Laboratory tests, muscle biopsy Elevated inflammatory markers (ESR, CRP), exclusion of other conditions
Treatment Immunosuppressive medications, physical therapy Corticosteroids, physical therapy
Prognosis Potential for long-term disability Generally responsive to treatment, favorable prognosis with proper management
Gender and Age Affects both genders, typically adults Predominantly affects older adults, more common in females
Symmetry of Symptoms Symmetrical muscle involvement Symmetrical joint and muscle pain

Diagnosis and treatment

Diagnosing Polymyositis and Polymyalgia Rheumatica

Polymyositis Diagnosis:

Medical History and Physical Examination:

  • Healthcare providers typically take a comprehensive medical history and conduct physical exams to assess muscle weakness, pain and other related symptoms.
  • They will likely inquire as to the onset and progression of symptoms before ordering blood tests to evaluate conditions further.

Blood Tests:

  • Blood tests play an integral part in diagnosing muscle damage. Elevated creatine kinase (CK) and aldolase levels may indicate muscle damage.
  • Autoantibodies such as anti-Jo-1 or anti-Mi-2 antibodies may be detected in blood, providing support for diagnosing Polymyositis as an autoimmune myopathy.

Electromyography (EMG):

  • EMG involves inserting small needles into muscles in order to assess their electrical activity, with abnormal patterns of muscle activity potentially signaling muscle disease.

Muscle Biopsy:

  • In order to make an accurate diagnosis, a muscle biopsy is often necessary.
  • In this process, a small piece of muscle tissue is extracted and examined under a microscope.
  • The biopsy can reveal any inflammation and help differentiate Polymyositis from other muscle disorders.

Imaging Studies:

  • When investigating PMR, magnetic resonance imaging (MRI) or computed tomography (CT) scans may be utilized to visualize muscle inflammation and assess its extent. They can also help provide valuable diagnostic insight. Eventually, a definitive diagnosis should be reached through a medical history review and physical examination.

Polymyalgia Rheumatic (PMR) Diagnosis:

Medical History and Physical Examination:

  • Healthcare providers typically take an extensive medical history and conduct physical exams to assess symptoms such as muscle pain, stiffness, or tenderness.
  • They may ask about systemic issues like fever or weight loss.

Blood Tests for PMR Diagnosis:

  • Blood tests are essential to diagnosing PMR. Elevated levels of inflammation markers like ESR and CRP, can be seen with PMR.
  • These markers help measure how much inflammation exists within your body.

Exclusion of Other Conditions:

  • PMR is diagnosed through exclusion; other potential conditions with similar symptoms (Rheumatoid Arthritis, Systemic Lupus Erythematosus or malignancies) must first be excluded using laboratory tests and imaging studies.

Response to Treatment:

  • To make an accurate assessment, the treatment response depends upon several factors including your response to treatment plans as well as laboratory results and imaging studies.
  • One key criterion for diagnosing PMR is rapid and significant relief of symptoms with low-dose corticosteroid treatment. A positive response suggests it might be PMR.

How do you treat Polymyositis and Polymyalgia Rheumatica?

Polymyositis Treatment Options:

Involve Treatment with Immunosuppressive Medication:

  • Polymyositis is an autoimmune condition; thus its primary treatment involves suppressing an abnormal immune response.
  • Commonly prescribed medications include corticosteroids such as prednisone at high doses initially in order to control inflammation.
  • Immunosuppressive agents like methotrexate, azathioprine or mycophenolate mofetil may be prescribed to reduce corticosteroid dependency or when corticosteroids alone are ineffective.

Physical Therapy:

  • Physical therapy can play an essential role in maintaining and improving muscle strength and function, helping patients manage muscle weakness, reduce disability, and regain independence in daily activities.

Occupational Therapy:

  • Occupational therapy can assist individuals in adapting their daily lives and environments in order to better accommodate muscle weakness or mobility challenges.

Regular monitoring by healthcare providers is key in order to assess treatment response monitor potential side effects of medications, and adjust doses according to each patient’s clinical status and blood test results. Complication Management:

Monitoring and Adjusting Medications:

  • Polymyositis may result in complications related to muscle weakness or medication side effects, including respiratory problems, infections or osteoporosis that require specific management.

Polymyalgia rheumatic (PMR) Treatment Options:


  • Prednisone is often prescribed at high dosages to manage PMR symptoms, initially to control inflammation and symptoms.

Gradual Tapering:

  • Once symptoms are under control, the corticosteroid dosage is gradually tapered down until it reaches its lowest effective dose, helping minimize potential side effects associated with the long-term use of steroids.

Regular Monitoring:

  • Patients living with PMR need regular monitoring from healthcare professionals in order to assess the response to treatment and manage potential side effects such as bone density loss and diabetes.

Pain Management:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain-relieving medicines may be combined with corticosteroids in order to manage pain and stiffness more effectively.

Lifestyle Modifications:

  • Patients are advised to adopt healthy behaviors, such as exercising regularly, following a balanced diet, and engaging in fall prevention strategies in order to enhance well-being and maximize well-being.

Are Polymyositis and Polymyalgia Rheumatica the same?


  • Nature of Condition: An Autoimmune Inflammatory Myopathy that Affects Muscles | Polymyositis is an autoimmune inflammatory myopathy that predominantly targets muscles, leading to weakness, atrophy and pain in these structures.
  • Age of Onset: It typically affects adults between 30-60.
  • Muscle Involvement: Polymyositis typically impacts skeletal muscles, leading to weakness that can result in significant disability.
  • Diagnostic Features: Diagnosis typically involves blood tests to identify elevated muscle enzyme levels and specific autoantibodies; electromyography (EMG); and finally muscle biopsy to confirm inflammation.
  • Treatment: Treatment options for polymyositis may include immunosuppressive medication such as corticosteroids or immunosuppressants and physical therapy to manage inflammation and muscle weakness.
  • Prognosis: Polymyositis could lead to long-term disability if left unmanaged properly, whilst Polymyalgia Rheumatica (PMR) should also be closely managed in order to ensure its long-term survival.

Polymyalgia rheumatic (PMR):

  • Condition Description: Pulmonary Artery Reflux Disease, or PMR, is an inflammatory disorder characterized by muscle pain and stiffness primarily in the shoulders, neck, and hip girdles. Its Age of Onset: PMR typically affects older adults; most cases occur among individuals 50 years old or over.
  • Muscle Involvement: PMR generally targets joints and soft tissues, leading to pain and stiffness, but does not lead to weakness or atrophy of muscles.
  • Diagnostic Features: Diagnosis usually relies on elevated inflammatory markers (ESR, CRP) in blood tests as well as clinical evaluation to rule out other conditions with similar symptoms.
  • Treatment: Corticosteroids are often effective treatments for PMR, providing rapid relief of symptoms. Many patients also report significant improvement.
  • Prognosis: With proper management, PMR generally responds well to treatments and often leads to a favorable prognosis.

Risks Associated with Polymyositis and Polymyalgia Rheumatica

Polymyositis and Polymyalgia Rheumatica (PMR) are autoimmune conditions, and while they can be managed with effective treatments, they do carry with them certain risks and potential complications that must be carefully managed to ensure maximum recovery.

Risks Associated with Polymyositis:

Polymyositis poses several significant risks, most notably muscle weakness and the use of immunosuppressant medications. Prolonged muscle weakness may limit one’s daily activities and significantly diminish quality of life. Long-term use of corticosteroids and immunosuppressive drugs may result in unwanted side effects, including osteoporosis, increased susceptibility to infection, weight gain, diabetes, and mood changes.

Polymyositis can lead to breathing difficulties that necessitate respiratory support.  Polymyositis increases your risk for malignancies like certain forms of cancer in older adults with this condition.

Polymyalgia Rheumatica Risks:

While PMR tends to respond well to treatment, there may be risks. Corticosteroids used as part of its regimen are the mainstay of its management and can result in side effects including osteoporosis, increased fracture risk, cataracts, glaucoma, hypertension, and diabetes – complications that can have lasting repercussions for health and well-being. While PMR alone typically is not linked with increased malignancy risk.

It may coexist or precede another condition known as giant Cell Arteritis Temporal Arteritis which increases malignancy risk by severalfold – even without directly contributing to increased malignancy risk if left untreated and promptly treated – including vision loss and even stroke as soon as treatment starts!

As with both conditions, close monitoring by healthcare professionals is key in effectively managing risks associated with these conditions. Balance must be struck between treatment benefits and possible side effects in managing Polymyositis and PMR in the long term, and tailored care plans designed specifically to address patient needs while mitigating associated risks.

Tips for Reducing the Polymyositis and Polymyalgia Rheumatica Risk.

Here are a few general lifestyle and health practices that may help reduce or alleviate some of these conditions:

  • Maintain a Healthy Lifestyle: Adopting healthy behaviors such as regular physical activity and diet are vital in order to achieve well-being and manage autoimmune responses more efficiently. A strong immune system could potentially aid the body in this endeavor.
  • Avoid Smoking: Smoking has been linked with inflammation and an increased risk of autoimmune conditions, so quitting may bring many health advantages including potentially decreasing that risk.
  • Avoid Stress: Chronic stress may aggravate or trigger autoimmune responses, so practicing stress reduction techniques such as mindfulness meditation or yoga may be useful in managing stress levels and decreasing inflammation.
  • Stay Active: Physical activity can help strengthen muscles, and increase flexibility and cardiovascular fitness – as well as counteracting some of the symptoms seen with these conditions. By staying active regularly, physical fitness may reduce some symptoms associated with them.
  • Vitamin D: According to some studies, deficiency of Vitamin D may play an indirect role in autoimmune diseases. Although sun exposure, food sources of Vitamin D or supplements may provide relief, healthcare providers should always be consulted first for guidance.
  • Infection Control: According to some theories, infections may trigger autoimmune responses in some individuals. Therefore, practicing good hygiene and reducing infection risks through vaccinations and preventive measures is crucial.
  • Regular Checkups: Scheduling regular medical check-ups is key to early identification and treatment of health conditions that increase the risk of autoimmune diseases, as well as for early diagnosis and management of any preexisting health conditions that might worsen existing ones.
  • Medication Awareness: Certain drugs have been linked with inducing autoimmune conditions. When being prescribed new medicines, it’s crucial that all potential risks and side effects are discussed with your healthcare provider in order to assess potential side effects or risks as soon as possible.

While these tips can promote  health and well-being, there is no guaranteed way of avoiding Polymyositis or PMR due to complex causes that remain unknown. If you have concerns or experience symptoms suggestive of these conditions, seeking professional evaluation and guidance early could make all the difference to outcomes in Polymyositis and PMR cases.


Polymyositis is a rare autoimmune condition affecting skeletal muscles, typically those between 30 and 60 years of age, that leads to muscle weakness, atrophy, and pain. Diagnosis involves laboratory tests or muscle biopsy procedures while treatment often includes immunosuppressant medications and physical therapy therapies. If left unmanaged it could result in long-term disability or permanent impairment.

Polymyalgia rheumatica (PMR), on the other hand, is an inflammatory condition primarily affecting older adults over 50. It causes muscle pain and stiffness primarily in shoulders, necks, and hip girdles as well as systemic symptoms like fatigue and weight loss.

Diagnosis relies on elevated inflammatory markers while exclusion of other conditions is used as criteria; corticosteroids and physical therapy typically provide effective relief; PMR typically responds positively to treatment plans; most patients experience significant symptom relief upon starting treatment plans.

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