What is Polymyalgia Rheumatica?
Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness in various parts of the body. It most commonly affects the:
The symptoms often appear suddenly and tend to be worse in the morning.
Polymyalgia rheumatica typically affects people over age 65. It rarely develops in those under age 50. Polymyalgia rheumatica is also more likely to occur in women than in men. People of Northern European and Scandinavian descent are at a higher risk for the condition as well.
Some people with polymyalgia rheumatica are also diagnosed with a related disorder called temporal arteritis. This condition causes inflammation of the blood vessels in the scalp, neck, and arms. Temporal arteritis can also cause headaches, jaw pain, and vision problems.
Causes of Polymyalgia Rheumatica
The cause of polymyalgia rheumatica isn’t known. However, it’s believed that certain genes and gene variations may increase your risk of developing polymyalgia rheumatica. Environmental factors may also play a role in the development of the disorder. New cases of polymyalgia rheumatic are often diagnosed in cycles and usually occur seasonally. This suggests that there may be an environmental trigger, such as a viral infection, that causes the condition. The rapid onset of symptoms also suggests that polymyalgia rheumatica may be caused by an infection. However, no such link has been found.
Symptoms of Polymyalgia Rheumatica
Pain and stiffness in the neck and shoulders are the most common symptoms of polymyalgia rheumatica. The pain and stiffness may gradually spread to other areas, such as the shoulders, hips, and thighs. These symptoms usually affect both sides of the body.
Other common symptoms of polymyalgia rheumatica include:
- loss of appetite
- sudden, unintentional weight loss
- anemia, or low red blood cell count
- low-grade fever
- limited range of motion
The symptoms of polymyalgia rheumatica develop quickly, usually over several days. In some cases, the symptoms may appear overnight. They tend to be worse in the morning and gradually improve throughout the day. For some people, being inactive and remaining in one position for a long period of time can make symptoms worse.
The pain and stiffness may eventually become so severe that people have difficulty performing everyday activities, such as standing up from the couch, getting dressed, or getting into a car. Sometimes, the symptoms of polymyalgia rheumatica can even make it difficult to fall sleep.
Diagnosis of Polymyalgia Rheumatica
The symptoms of polymyalgia rheumatica can be similar to those of other inflammatory conditions, including lupus and arthritis. To make an accurate diagnosis, your doctor will perform a physical exam and run several tests to check for inflammation and blood abnormalities.
During the exam, your doctor may gently move your neck, arms, and legs to evaluate your range of motion. If polymyalgia rheumatica is suspected, they may order blood tests to check for signs of inflammation in your body. These tests will measure your erythrocyte sedimentation rate and C-reactive protein levels. An abnormally high sedimentation rate and elevated C-reactive protein levels usually are suggestive of inflammation.
Your doctor may also schedule an ultrasound to check for inflammation in your joints and tissues. An ultrasound uses high-frequency sound waves to create detailed images of the soft tissue in different parts of the body. This can be very helpful in distinguishing polymyalgia rheumatica from other conditions that cause similar symptoms.
Since there’s a link between polymyalgia rheumatica and temporal arteritis, your doctor may want to perform a biopsy. This biopsy is a simple, low-risk procedure that involves the removal of a small sample of tissue from an artery in your temple. The sample is sent to a laboratory and analyzed for signs of inflammation. A biopsy is only necessary if your doctor suspects inflammation in the blood vessels.
The signs of temporal arteritis include:
- persistent headaches
- blurred or double vision
- vision loss
- tenderness in the scalp
- jaw pain
Treatment of Polymyalgia Rheumatica
There’s no cure for polymyalgia rheumatica. With the proper treatment, however, symptoms can improve in as little as 24 to 48 hours. Your doctor will prescribe a low-dose corticosteroid, such as prednisone, to help reduce inflammation. The typical dosage is 10 to 30 milligrams per day. Over-the-counter pain medications, such as ibuprofen and naproxen, aren’t effective in treating the symptoms of polymyalgia rheumatica.
Although corticosteroids are effective in treating polymyalgia rheumatica, these drugs do have side effects. Long-term use of these medications increases your risk of:
- high blood pressure
- high cholesterol
- weight gain
- diabetes or high levels of sugar in the blood
- osteoporosis, which is loss of bone density
- cataracts, which is clouding in the lens of the eye
To reduce your risk of having any side effects during treatment, your doctor may recommend that you take a daily calcium and vitamin D supplement. Supplements are often recommended if you’re taking corticosteroids for more than three months. Your doctor may also suggest physical therapy to help improve your strength and increase your range of motion.
Shop for calcium supplements.
Shop for vitamin D supplements.
Making healthy lifestyle choices can also help reduce the side effects of corticosteroids. Eating a healthy diet and limiting your salt intake can help prevent high blood pressure. Regular exercise can help strengthen your bones and muscles and prevent weight gain.
Your doctor will carefully monitor your health during treatment. They may periodically order blood tests to check your cholesterol and blood sugar levels, recommend annual eye exams, and schedule periodic bone density tests to check for signs of osteoporosis. Your doctor might also reduce your dosage after three or four weeks of treatment if your symptoms are improving.
If your symptoms don’t improve with medication, then polymyalgia rheumatica may not actually be the cause of your pain and stiffness. In this case, your doctor will run additional tests to check for other rheumatic disorders, such as osteoarthritis and rheumatic fever.
Complication of Polymyalgia Rheumatica
Polymyalgia rheumatica symptoms can interfere with everyday activities, especially if the condition goes untreated. Without appropriate treatment, the pain and stiffness can severely reduce mobility. You may eventually become unable to complete simple tasks on your own, such as bathing, getting dressed, and combing your hair. Some people also experience a temporary loss of joint function. This increases the risk of developing lingering joint problems, such as frozen shoulder.
People with polymyalgia rheumatica are also more likely to develop peripheral artery disease. This condition impairs blood circulation and often causes leg pain and ulcers.
Long-Term Outlook of Polymyalgia Rheumatica
There’s no cure for polymyalgia rheumatica. However, polymyalgia rheumatica often improves once treatment is received. In fact, the condition typically goes away after two to six years of treatment.