Polymyalgia Rheumatica

What is polymyalgia rheumatica?

Polymyalgia rheumatica (PMR) is an inflammatory condition that can cause aching and stiffness. It tends to affect the neck, shoulders, and hips. The aching and stiffness are usually worse in the morning.

PMR can come on suddenly. For some, it seems to happen overnight. For others, it can take days or weeks to develop. PMR affects only older adults. It becomes more common with age. PMR happens most often between the ages of 70 and 80. It can be seen as early as 50 years of age. It's more common in women than in men, and it seems to run in some families.

What causes polymyalgia rheumatica?

The cause of PMR is not completely understood. Researchers think it is an autoimmune disorder. This means that the body's own immune system attacks healthy cells. Researchers are working to understand the causes of PMR. Because it can happen quickly and tends to happen at certain times of year, some think that an infection may cause it. Genes may be part of the cause as well, because PMR can run in some families.

Who is at risk for polymyalgia rheumatica?

Some things seem to increase the risk of polymyalgia rheumatic. These include:

• Being older (age 50 or older).

• Being Caucasian, especially of Scandinavian descent.

• Being female.

What are the symptoms of polymyalgia rheumatica?

The main symptoms of PMR are aching and stiffness of the shoulders, neck, and hips. The aching can extend to the upper arms and thighs. PMR tends to affect both sides of the body equally. Symptoms are often worse in the morning or after long periods of no activity. Movement can make the pain worse.

The symptoms of PMR usually affect the shoulders the most. You may have trouble raising your arms above the level of your shoulders. This can make it hard to get dressed. You may have trouble rolling over in bed, getting out of bed, and getting up from sitting. You may also have trouble sleeping because of your symptoms.

Other symptoms can happen, such as:

• Swelling of the hands, wrists, feet, and ankles.

• Numbness, tingling, or pain in the hand, wrist, or forearm.

• A feeling of weakness.

• A general feeling of being unwell.

• Feeling tired.

• Loss of appetite.

• Weight loss.

• A low-grade fever.

Some people with PMR also have a condition called giant cell arteritis, also called temporal arteritis or Horton arteritis. This is inflammation of blood vessels in the head, neck, and arms. This can narrow or block the blood vessels. It can cause problems from less blood flowing through those vessels. Giant cell arteritis can cause symptoms, such as:

• Headaches.

• Changes in vision.

• Jaw pain, especially when chewing.

• Scalp pain.

• Scalp sores (ulcers).

• High fevers.

• Cough.

How is polymyalgia rheumatica diagnosed?

Your doctor will ask about your health history and your symptoms. They will give you a physical exam. The exam will check your range of motion, strength, and painful areas.

Diagnosing PMR can be difficult. Your doctor will need to make sure you have PMR. Many conditions can cause aching and stiffness. These include rheumatoid arthritis, myositis, and fibromyalgia. You may need tests, such as:

• Blood tests to look for signs of inflammation, blood count problems, and muscle damage.

• A muscle biopsy to check for damage.

• X-rays to look at your joints.

• An MRI for detailed pictures of your joints and tissues.

• Ultrasound scans to look closely at the soft tissues surrounding your joints.

If your doctor suspects giant cell arteritis, they may do tests such as:

• Ultrasound of the temporal and axillary arteries.

• Biopsy of the temporal artery (blood vessel in the temple).

Your doctor may also diagnose you by giving you medicine. PMR often responds quickly to steroid medicine. This can help show if you have PMR. You may also be referred to a rheumatologist for diagnosis.

How is polymyalgia rheumatica treated?

Steroid medicine is the main treatment for PMR. Your doctor will start you on a low dose of this medicine. You should start to feel better soon after starting. When your symptoms are better, your doctor will slowly lower the amount of medicine. If your symptoms return, the doctor will increase the dose. You may need to take steroids for a few years. Return of symptoms is common, so you may need to take steroids again in the future. If untreated, PMR may go away on its own after several years. But symptoms will likely return.

What are possible complications of polymyalgia rheumatica?

Polymyalgia rheumatica doesn’t have any specific complications. But possible complications of giant cell arteritis may include blindness or stroke. Giant cell arteritis can also be treated with steroids.

Steroids have some risks. Talk with your doctor about the risks and benefits for you. Some of the possible risks of taking steroids for a long time can include:

• High blood pressure.

• Diabetes.

• Glaucoma.

• Cataracts.

• Thinning bones (osteoporosis/osteopenia).

• Fluid retention.

• Weight gain.

• Roundness of the face.

• Stomach irritation.

• Trouble sleeping.

• Muscle wasting.

• Skin thinning.

• Easy bruising.

• Poor wound healing.

• Increased infection risk.

How to manage polymyalgia rheumatica

If you have PMR, your symptoms will get better with treatment. When you start feeling better, you can return to your normal activities. Your doctor will track your symptoms and adjust your steroid dose until you are on the lowest dose needed. Small changes in steroid doses can have a big effect on your symptoms. Make sure to follow your doctor’s instructions.

When to contact the doctor

Contact your doctor if you have:

• Symptoms that don’t get better with treatment.

• Symptoms that get worse.

• Symptoms of giant cell arteritis, such as a headache, loss of a visual field, or jaw pain with chewing.

Key points about polymyalgia rheumatic

• PMR is an inflammatory condition.

• Common symptoms include aching and stiffness of the neck, shoulders, and hips. These symptoms are usually worse in the morning.

• PMR is rarely seen in people younger than 50.

• Some people who develop PMR also develop giant cell arteritis.

• The specific causes of PMR and giant cell arteritis are unknown.

• Both conditions get better with steroid therapy.

Next steps

Here are some tips to help you get the most from a visit to your doctor:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your doctor tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your doctor gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you don't take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your doctor if you have questions, especially after office hours and on weekends and holidays.