Diagnosis

A physical exam, including joint and neurological exams, and test results can help your doctor determine the cause of your pain and stiffness. During the exam, he or she might gently move your head and limbs to assess your range of motion.

Your doctor might reassess your diagnosis as your treatment progresses. Some people initially given a diagnosis of polymyalgia rheumatica are later reclassified as having rheumatoid arthritis.

Tests your doctor might recommend include:

  • Blood tests. Besides checking your complete blood counts (CBCs), your doctor will look for two indicators of inflammation — erythrocyte sedimentation rate (sed rate) and C-reactive protein. However, not everyone with this condition has elevated levels.
  • Imaging tests. Increasingly, ultrasound is being used to distinguish polymyalgia rheumatica from other conditions that cause similar symptoms. MRI can also identify other causes of shoulder pain, such as joint changes.

Monitoring for giant cell arteritis

Your doctor will monitor you for signs and symptoms that can indicate the onset of giant cell arteritis. Talk to your doctor immediately if you have 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 might 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, involves removing a small sample of the artery, which is then examined for inflammation.

Treatment

Treatment usually involves medications to help ease your signs and symptoms. Relapses are common.

Corticosteroids

Polymyalgia rheumatica is usually treated with a low dose of an oral corticosteroid, such as prednisone. You'll likely start to feel relief from pain and stiffness within the first two or three days.

After the two to four weeks of treatment, your doctor might begin to 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 have side effects.

People who start at higher doses or taper off the medication too quickly are more likely to have a relapse. More than half of the people with polymyalgia rheumatica 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 serious side effects. Your doctor will monitor you closely for problems. He or she might adjust your dose and prescribe treatments to manage reactions to corticosteroid treatment. Possible side effects include:

  • Weight gain
  • Loss of bone density and weakening of bones (osteoporosis)
  • High blood pressure (hypertension)
  • Diabetes
  • Clouding of the lenses of your eyes (cataracts)

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 College 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

Methotrexate

Joint guidelines from the American College of Rheumatology and the European League Against Rheumatism suggest using methotrexate (Trexall) with corticosteroids in some patients. This is an immune-suppressing medication that is taken by mouth. It may be useful early in the course of treatment or later, if you relapse or don't respond to corticosteroids.

Physical therapy

Most people who take corticosteroids for polymyalgia rheumatic return to their previous levels of activity. However, if you've had a long stretch of limited activity, you might benefit from physical therapy. Talk with your doctor about whether physical therapy is a good option for you.

Lifestyle and home remedies

Over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (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.
  • Get enough rest. Rest is necessary to give your body time to recover for exercise and activities of daily living.
  • Use assistive devices. Consider using luggage and grocery carts, reaching aids, shower grab bars, and other assistive devices to help make daily tasks easier.

Coping and support

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 might also know of local support groups in your area. Talking to others who are living with the same illness and challenges can be helpful.

Preparing for your appointment

You'll likely start by seeing your primary care doctor, who might refer you to a specialist in inflammatory disorders of muscles and the skeletal system (rheumatologist).

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began
  • Key personal information, including major stresses or recent life changes, and personal and family medical history
  • Any medications, vitamins and supplements you take, including doses
  • Questions to ask your doctor

Ask a family member or friend to come with you, if possible, to help you remember the information you receive.

For polymyalgia rheumatica, questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • What are other possible causes of my symptoms?
  • What tests do I need? Do they require special preparation?
  • Is this a temporary or long-lasting condition?
  • 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 them together?
  • Do you have brochures or other printed material that I can have? What websites do you recommend?

What to expect from your doctor

Your doctor will likely ask you questions, such as:

  • Where is the pain or stiffness located?
  • How would you rate your pain on a scale of 1 to 10?
  • Are symptoms worse at certain times of the day or night?
  • How long does stiffness last after you wake in the morning or after a period of inactivity?
  • Does the pain or stiffness limit your activities?
  • Have you had new or severe headaches or jaw pain?
  • Have you noticed changes in your vision?
June 23, 2018
References
  1. Docken WP. Clinical manifestations and diagnosis of polymyalgia rheumatic. https://www.uptodate.com/contents/search. Accessed June 3, 2018.
  2. Dejaco C, et al. Giant cell arteritis and polymyalgia rheumatica: Current challenges and opportunities. Nature Reviews: Rheumatology. 2017;13:592.
  3. Patient fact sheet: Polymyalgia rheumatic. American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Polymyalgia-Rheumatica. Accessed June 3, 2018.
  4. Docken WP. Treatment of polymyalgia rheumatic. https://www.uptodate.com/contents/search. Accessed June 3, 2018.
  5. Polymyalgia rheumatic. Arthritis Foundation. https://www.arthritis.org/about-arthritis/types/polymyalgia-rheumatica/. Accessed June 3, 2018.
  6. Buckley L, et al. 2017 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis & Rheumatology. 2017;69:1521.
  7. Dejaco C, et al. 2015 Recommendations for the management of polymyalgia rheumatica: A European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis & Rheumatology. 2015;67:2569.