Polymyalgia rheumatica, or PMR, is a chronic inflammatory disease that affects the major muscle groups of the body. The hip area, neck, and shoulders are some of the most affected regions. PMR is one of the most common rheumatic conditions in the demographic of people over 50 years old. The condition is also relatively more prevalent in females than in males. Despite its prevalence, the condition is difficult to diagnose and treat since no specific tests or definite causes exist.

Genetic predisposition
Genetic factors are one of the common causes of polymyalgia rheumatica. The condition may affect individuals who have a family history of the condition or a related autoimmune condition. Therefore, PMR may also affect individuals prone to giant cell arthritis or rheumatoid arthritis. There is still some ongoing research to help find the genetic markers that make individuals more susceptible to PMR.

Immune system dysfunction
Another factor that can play a functional role in the pathogenesis of PMR is the immune system. When the system shows signs of dysfunction, it can attack the healthy cells in the body and result in increased inflammation and pain. It can make things more difficult for the patient by triggering the affected areas. Although, it has not yet been determined what exactly triggers this malfunction of the immune system. Bacterial and viral infections are some possible triggers.

Inflammatory response to infections
As discussed above, some viral and bacterial infections are suspected to cause PMR. Certain microbes that impact the respiratory system can also be regarded as potential causative agents for polymyalgia rheumatica. Theoretically, it is believed that the immune system responds to these infections in the body, and the process leads to increased inflammation. This attack by the immune system can also make the affected individuals more susceptible to the occurrence of PMR. However, like other possible causes, more research and proof are needed to establish a proper link between some pathogens and their role in PRM onset.

Environmental factors
Another possible cause of polymyalgia rheumatica is the environmental factors surrounding the individual.   Many people are exposed to a wide variety of toxins and pollutants in their daily lives. These chemicals can play a role in the development of PMR. In some cases, they might even exacerbate other conditions that can fast-track the process of onset. It is believed that environmental factors can also interact with the genetic traits that make individuals more susceptible to the condition. They can also enhance the immune system dysfunction, perpetuating the inflammatory process and aggravating the pain in affected tissues.

Age and hormonal changes
The age group of 50 years and above is the primary demographic of PMR. The most documented cases of the condition are in people who have reached or crossed 70 years. This indicates that age-related changes in an individual’s hormonal levels and immune system can act as a contributing factor. Hormonal fluctuations can send the immune system into a tizzy and might affect the patient’s ability to fight off the condition’s onset. In particular, the fluctuations in the levels of the hormone cortisol have been found to significantly impact the disease’s pathogenesis.

Autoimmune mechanisms
PMR is often considered an autoimmune condition where the body’s immune system mistakes healthy cells and tissues for foreign entrants and starts attacking them. As suggested earlier, due to a lack of concrete research, it is hypothesized that a faulty autoimmune mechanism could also contribute as a causative factor in PMR onset. The process is believed to be driven by immune cells, signaling pathways, and the inflammatory cytokines responsible for the body’s inflammatory response. However, the specific triggers that initiate and perpetuate these autoimmune mechanisms remain the subject of ongoing research.

It is difficult to comment on or pinpoint what caused a particular PMR onset as the causes remain elusive. However, the possible reasons are believed to be a complex involvement of autoimmune malfunction, genetic predisposition, aging, environment, and fluctuating hormones. It is, therefore, important to pay special attention to possible causes and triggers to provide proper treatment and management options to the patients. These options can help improve the patient’s quality of life and help maintain their active daily routine.

Stress
Patients often ask, can stress trigger polymyalgia rheumatica? And the simple answer is yes. Psychological stressors that affect the person’s physical and emotional state can act as active sources that exacerbate their symptoms. Stress has also been known to increase the inflammation in the body and subsequently worsen the patient’s pain, fatigue, and stiffness. PMR patients are often advised to adopt stress management techniques, including mindful breathing practices, relaxation, low-impact exercises, indulging in hobbies, and spending time in nature.

Infections
Infections are another potential trigger that can make things difficult for PMR patients. However, the exact mechanism of how it affects the patient is yet to be determined. It is believed that when patients contract specific viral or bacterial infections, their immune response is triggered. The immune system then activates an inflammatory response in an attempt to deal with the pathogen and infected cells. However, since the patients of PMR are already dealing with high inflammation, the immune response against the infections can aggravate their existing symptoms. Some might experience frequent flare-ups when dealing with an infection.

Treatment
Some treatments that affect the immune system of individuals might also act as a trigger for PMR patients. If a patient is receiving treatment for an underlying autoimmune condition or any immunity-altering treatment, they need to be closely monitored for any sign of PMR. Close monitoring of side effects and symptoms is essential for accurate diagnosis and management of PMR.