Definition

What is polymyalgia rheumatica?

Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders. Symptoms of polymyalgia rheumatica usually begin quickly and are worse in the morning.

How common is polymyalgia rheumatica?

Most people who develop polymyalgia rheumatica are older than 65. It rarely affects people under 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. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of polymyalgia rheumatica?

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
  • Fatigue
  • A general feeling of not being well (malaise)
  • Loss of appetite
  • Unintended weight loss
  • Depression

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my 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

Causes

What causes 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.

Risk factors

There are many risk factors for polymyalgia rheumatica, such as:

  • 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.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is polymyalgia rheumatica diagnosed?

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

How is polymyalgia rheumatica treated?

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

Corticosteroids

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 12 to 25 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 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’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)
  • Diabetes
  • 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

Pneumonia vaccine

Your doctor may suggest you get a pneumonia vaccine if you are taking 20 milligrams or more of prednisone a day.

Methotrexate (Trexall)

Joint guidelines from the American Academy of Rheumatology and the European League Against Rheumatism suggest using methotrexate 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

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.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage polymyalgia rheumatica?

The following lifestyles and home remedies might help you cope with polymyalgia rheumatica:

  • 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.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: July 20, 2017 | Last Modified: July 20, 2017

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