Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders. Symptoms of polymyalgia rheumatica (pol-e-my-AL-juh rue-MAT-ih-kuh) usually begin quickly and are worse in the morning. Most people who develop polymyalgia rheumatica are older than 65. It rarely affects people under 50.
You may receive symptom relief by taking anti-inflammatory drugs called corticosteroids. But relapses are common, and you'll need to visit your doctor regularly to watch for serious side effects of these drugs.
Polymyalgia rheumatica is related to another inflammatory disorder called giant cell arteritis, which can cause headaches, vision difficulties, jaw pain and scalp tenderness. 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:
- Aches or pain in your shoulders (often the first symptom)
- Aches or pain in your neck, upper arms, buttocks, hips or thighs
- Stiffness in affected areas, particularly in the morning or after being inactive for a long time
- Limited range of motion in affected areas
- Pain or stiffness in your wrists, elbows or knees (less common)
You may also have more general signs and symptoms, including:
- Mild fever
- A general feeling of not being well (malaise)
- Loss of appetite
- Unintended weight loss
When to see a doctor
See your doctor if you experience aches, pains or stiffness that:
- Is new
- Disrupts your sleep
- Limits your ability to do your usual activities of daily living, such as getting dressed
The exact cause of polymyalgia rheumatica is unknown. Two factors appear to be involved in the development of this condition:
- Genetics. Certain genes and gene variations may increase your susceptibility.
- An environmental exposure. New cases of polymyalgia rheumatica tend to come in cycles and may develop seasonally. This suggests that an environmental trigger, such as a virus, might play a role. But no specific virus has been shown to cause polymyalgia rheumatica.
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 can cause headaches, jaw pain, vision problems and scalp tenderness. If left untreated, it can lead to stroke or blindness.
Polymyalgia rheumatica and giant cell arteritis may actually be the same disease but with different manifestations. The overlap between the two diseases is significant:
- About 20 percent of people with polymyalgia rheumatica also have signs and symptoms of giant cell arteritis.
- About half of the people with giant cell arteritis may also have polymyalgia rheumatica.
Risk factors for polymyalgia rheumatica include:
- Age. Polymyalgia rheumatica affects older adults almost exclusively. The average age at onset of the disease is 73.
- Sex. Women are about two times more likely to develop the disorder.
- Race and geographic region. Polymyalgia rheumatica is most common among whites in northern European populations.
Symptoms of polymyalgia rheumatica can greatly affect your ability to perform everyday activities. The pain and stiffness may contribute to difficulties with tasks such as the following:
- Getting out of bed, standing up from a chair or getting out of a car
- Bathing or combing your hair
- Getting dressed or putting on a coat
These difficulties can affect your health, social interactions, physical activity, sleep and general well-being.
In addition, people with polymyalgia rheumatica seem to be more likely to develop peripheral arterial disease.
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, it's a good idea to arrive well-prepared. Here's some information to help you get ready for your appointment.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- List any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- List key personal information, including any major stresses or recent life changes. It's also helpful to bring the name and contact information of any doctor you have seen recently or see regularly.
- Make a list of all medications, vitamins and supplements that you're taking, along with the dosage for each.
- Ask a family member or friend to come with you, if possible. In addition to offering support, he or she can write down information from your doctor or other clinic staff during the appointment.
- List questions to ask your doctor.
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:
- What's the most likely cause of my symptoms?
- What are other possible causes for my symptoms?
- What tests do I need? Do they require any special preparation?
- Is this condition temporary or long-lasting?
- What treatments are available, and which do you recommend?
- What side effects can I expect from treatment?
- What are alternatives to the primary approach that you're suggesting?
- I have other health conditions. How can I best manage these conditions together?
- Is there a generic alternative to the medicine you're prescribing?
- Do you have any brochures or other printed material that I can take with me? What websites do you recommend?
What to expect from your doctor
Your doctor will likely ask you a number of questions, such as:
- Where is the pain or stiffness located?
- When did the symptoms begin?
- How would you rate your current level of pain on a scale of 1 to 10?
- Are symptoms worse at certain times of day or night?
- How long does stiffness last after you wake in the morning or after a long period of inactivity?
- Does the pain or stiffness limit your activities? Are you avoiding any activities because of the symptoms?
- Have you experienced similar episodes of pain or stiffness in the past? Was the condition diagnosed and treated?
- Have you experienced any new or severe headaches?
- Have you noticed any changes in your vision?
- Have you experienced any jaw pain?
Your answers to questions, a general physical exam and the results of tests can help your doctor determine the cause of your pain and stiffness. This diagnostic process also helps your doctor rule out other disorders that have similar symptoms to polymyalgia rheumatica.
Your doctor may reassess your diagnosis as your treatment progresses. Studies show that 2 to 30 percent of people initially given a diagnosis of polymyalgia rheumatica were later reclassified as having rheumatoid arthritis.
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 assess whether 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 two indicators of inflammation — sed rate (erythrocyte sedimentation rate) and C-reactive protein.
Increasingly, ultrasound is being used to distinguish polymyalgia rheumatica from other conditions that cause similar symptoms. Magnetic resonance imaging (MRI) can also identify other causes of shoulder pain, such degenerative joint changes.
Monitoring for giant cell arteritis
Your doctor will monitor you for signs and symptoms that may indicate the onset of giant cell arteritis. Talk to your doctor immediately if you experience any of the following:
- New, unusual or persistent headaches
- Jaw pain or tenderness
- Blurred or double vision or visual loss
- Scalp tenderness
If your doctor suspects you may have giant cell arteritis, he or she will likely 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 usually involves medications to help ease your symptoms. Relapses are common.
Polymyalgia rheumatica is usually treated with a low dose of an oral corticosteroid, such as prednisone. A daily dose at the beginning of treatment is usually 10 to 20 milligrams a day.
You'll likely start to feel relief from pain and stiffness within the first two or three days. If you aren't responding to treatment, your doctor may refer you to a rheumatologist.
After the first two to four weeks of treatment, your doctor may gradually decrease your dosage depending on your symptoms and the results of blood 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 at least a year. You'll need frequent follow-up visits with your doctor to monitor how the treatment is working and whether you're having any side effects.
People who taper off the medication too quickly are more likely to have a relapse. Thirty to 60 percent of people with polymyalgia rheumatica will have at least one relapse when tapering off the corticosteroids. Relapses (flares) are treated by increasing your drug dosage for a while then tapering again.
Monitoring side effects
Long-term use of corticosteroids can result in a number of serious side effects. Your doctor will monitor you closely for problems. He or she may adjust your dosage and prescribe treatments to manage these reactions to corticosteroid treatment. Possible side effects include:
- Weight gain
- Osteoporosis — the loss of bone density and weakening of bones
- High blood pressure (hypertension)
- Cataracts — a clouding of the lenses of your eyes
Calcium and vitamin D supplements
Your doctor will likely prescribe daily doses of calcium and vitamin D supplements to help prevent bone loss induced by corticosteroid treatment. The American Academy of Rheumatology recommends the following daily doses for anyone taking corticosteroids:
- 1,200 to 1,500 milligrams (mg) of calcium supplements
- 800 to 1,000 international units (IU) of vitamin D supplements
Your doctor may suggest you get a pneumonia vaccine if you are taking 20 milligrams or more of prednisone a day.
Several other medications are being studied for use in polymyalgia rheumatica, including:
- Methotrexate (Trexall). Three studies show mixed results for the usefulness of this immune-suppressing medication when taken with prednisone. Two studies show that methotrexate is useful as an initial treatment. Another shows that it doesn't help lower the dose of corticosteroid that's needed, which can help preserve bone mass.
- Anti-TNF drugs. TNF stands for tumor necrosis factor, which is a substance that causes inflammation. Anti-TNF drugs block that substance and reduce inflammation. Research results are mixed on using these drugs to treat polymyalgia rheumatic. But studies also show that they might be helpful for people with polymyalgia rheumatica who can't take corticosteroids, such as those with diabetes or osteoporosis.
You may benefit from physical therapy if you've had a long stretch of limited activity owing to polymyalgia rheumatica. Talk with your doctor about whether physical therapy is a good option for you if you're trying to regain strength, coordination and the ability to perform everyday tasks.
Over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve), are not usually recommended for easing the signs and symptoms of polymyalgia rheumatica.
Healthy lifestyle choices can help you manage the side effects that may result from corticosteroid treatment:
- Eat a healthy diet. Eat a diet of fruits, vegetables, whole grains, and low-fat meat and dairy products. Limit the salt (sodium) in your diet to prevent fluid buildup and high blood pressure.
- Exercise regularly. Talk to your doctor about exercise that is appropriate for you to maintain a healthy weight and to strengthen bones and muscles.
- Use assistive devices. Use luggage and grocery carts, reaching aids, shower grab bars and other assistive devices to help make daily tasks easier. Take steps to minimize the risk of falls, such as wearing low-heeled shoes. Talk to your doctor about whether the use of a cane or other walking aid is appropriate for you to prevent falls or other injury.
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.
July 14, 2015
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