Filed under: Heart & Vascular
Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness. The pain and stiffness often occur in your shoulders, neck, upper arms and hips. Symptoms of polymyalgia rheumatica (pol-ee-my-AL-juh roo-MA-ti-kah) usually begin quickly, within two weeks.
Most people who develop polymyalgia rheumatica are older than 65. It rarely affects people younger than 50.
Anti-inflammatory drugs called corticosteroids improve the symptoms of polymyalgia rheumatica, but these drugs require careful monitoring for serious side effects.
Polymyalgia rheumatica is related to another inflammatory disorder called giant cell arteritis, which can cause headaches, vision difficulties, jaw pain and other symptoms. It's possible to have both of these conditions together.
The signs and symptoms of polymyalgia rheumatica usually occur on both sides of the body and may include:
You may also have more general signs and symptoms, including:
When to see a doctor
See your doctor if you experience aches, pains or stiffness that:
The exact cause of polymyalgia rheumatica is unknown. However, there are two factors that appear to be involved in the development of this condition, including:
Giant cell arteritis
Polymyalgia rheumatica and another disease known as giant cell arteritis share many similarities. Giant cell arteritis results in inflammation in the lining of arteries, most often the arteries located in the temples. Giant cell arteritis usually causes headaches, jaw pain, vision problems and scalp tenderness. It can lead to permanent vision loss.
Polymyalgia rheumatica and giant cell arteritis may actually be the same disease but with different manifestations. The overlap between the two diseases is significant:
Risk factors for polymyalgia rheumatica include:
Symptoms of polymyalgia rheumatica can greatly affect a person's ability to perform everyday activities. The pain and stiffness may contribute to difficulties with the following tasks:
These complications can affect a person's health, social interactions, physical activity, sleep and general well-being.
If you're experiencing aches, pains or stiffness in joints or muscles, you'll probably see your primary care doctor first. You may then be referred to a specialist in inflammatory disorders of muscles and the skeletal system (rheumatologist).
Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to arrive well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. For polymyalgia rheumatica, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.
What to expect from your doctor
Your doctor will likely ask you a number of questions. Be prepared to answer the following:
Your answers to questions, a general physical exam and the results of tests can help your doctor determine the cause of pain and stiffness.
Your doctor will conduct an exam to get an idea of your overall health, identify possible causes or rule out certain diseases. He or she may gently move your head and limbs to judge how much your symptoms affect your range of motion.
A nurse or assistant will draw a sample of your blood. This sample will be used for several laboratory tests that your doctor will order. Typically, your doctor will check the complete blood counts (CBC) and for signs of inflammation, but your doctor also may recommend additional tests to rule out other conditions that have similar symptoms to polymyalgia rheumatica.
Test results helpful in making a diagnosis of polymyalgia rheumatica include the following:
Your doctor may use magnetic resonance imaging (MRI) or ultrasound imaging to find inflammation of tissues within the shoulder and hip joints that can support a diagnosis of polymyalgia rheumatica. These images may also help identify or rule out other causes of your symptoms. Ultrasound imaging uses sound waves to produce images, while MRI relies on radio waves and a magnetic field to create images. Neither procedure exposes you to radiation.
Monitoring for giant cell arteritis
Your doctor will monitor you for signs or symptoms that may indicate the onset of giant cell arteritis. Talk to your doctor immediately if you experience any of the following symptoms:
If your doctor suspects a diagnosis of giant cell arteritis, he or she will order a biopsy of the artery in one of your temples. This procedure, performed during local anesthesia, removes a tiny sample of the artery, which is then examined in a laboratory for signs of inflammation.
Treatment can take a year or more, but most people with polymyalgia rheumatica will be better after the first course of treatment. And you'll start to feel better within days. Some people, however, will have a relapse and need additional treatment.
Polymyalgia rheumatica is usually treated with a low dose of an oral corticosteroid, such as prednisone. A daily dose at the beginning of the treatment is usually 10 to 20 milligrams a day.
Relief from pain and stiffness should occur within the first two or three days. If you're not feeling better in a few days, it's likely you don't have polymyalgia rheumatica. In fact, your response to medication is one way your doctor can confirm the diagnosis.
After the first two to three weeks of treatment, your doctor may gradually decrease your dosage depending on your symptoms and the results of sed rate and C-reactive protein tests. The goal is to keep you on as low a dose as possible without triggering a relapse in your symptoms. Most people with polymyalgia rheumatica need to continue the corticosteroid treatment for one to two years. You'll need frequent follow-up visits to monitor how the treatment is working and whether or not you're having any side effects.
People who taper off the medication too quickly are more likely to have a relapse. Twenty percent or more of people with polymyalgia rheumatica will have a least one relapse when tapering off the corticosteroids. About 10 percent of people who successfully finish corticosteroid treatment will have a relapse within 10 years of the initial treatment.
Monitoring side effects
Long-term use of corticosteroids can result in a number of serious side effects. Your doctor will monitor you closely for potential problems. He or she may adjust your dosage and prescribe treatments to manage these reactions to corticosteroid treatment. Side effects include:
Calcium and vitamin D supplements
Your doctor will likely prescribe daily doses of calcium and vitamin D supplements to help prevent osteoporosis induced by corticosteroid treatment. The American Academy of Rheumatology recommends the following daily doses for anyone taking corticosteroids for more than three months:
Several other medications are being studied for use in polymyalgia rheumatica, including:
Your doctor may recommend physical therapy to help you regain strength, coordination and your ability to perform everyday tasks after a long period of limited activity that polymyalgia rheumatica often causes.
Healthy lifestyle choices can help you manage the side effects that may result from corticosteroid treatment:
Even though you'll start to feel better soon after you begin treatment, it can be frustrating having to take medication daily, especially one that can cause such serious side effects. Ask your health care team what steps you can take to stay healthier while you're taking corticosteroids. Your doctor may also know if there are any local support groups in your area. Talking to others who are living with the same illness and challenges can be helpful and encouraging.