Occasionally, small-joint synovitis may be seen. Patients usually experience stiffness that is particularly worse after rest and may prevent them from getting out of bed. These symptoms may be accompanied by fatigue, depression and weight loss. Affected structures feel tender, leading to restricted shoulder movement if diagnosis is delayed. Muscular pain is often diffuse and is aggravated by movement.
Muscle strength is unaffected, but the pain makes interpretation of muscle power testing difficult.
Persistent synovitis is uncommon and may suggest an alternative diagnosis such as rheumatoid arthritis. The differential diagnosis of muscle pain, stiffness and a raised ESR is indeed large. PMR is distinguished from polymyositis by the presence of a normal CPK and the absence of muscle weakness. Treatment includes corticosteroids 10-20 mg daily, gradually reducing doses to 5 mg daily. Most patients require treatment for three to four years but it is worth attempting to withdraw after two.