Polymyalgia Rheumatica

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Introduction

What is polymyalgia rheumatica?

Polymyalgia rheumatica is a disorder that results in severe pain and stiffness of large muscle groups in the body. Although its exact cause is not known, it may be due to a disruption in the function of the body’s immune system. Polymyalgia rheumatica primarily affects adults over the age of 50, and women are affected twice as often as men. Overall, the condition affects 0.7% of adults over the age of 50, or approximately 1.9 million adults in the United States (Source: NIAMS).

Symptoms of polymyalgia rheumatica tend to appear suddenly and are usually moderate to severe in intensity. Muscle pain and stiffness are the characteristic symptoms. The neck, hips and shoulders are the areas most commonly affected.

Making a diagnosis of polymyalgia rheumatica can be difficult because there are no specific tests to confirm the presence of the disease. In addition, the diagnosis is sometimes missed or delayed because the symptoms of polymyalgia rheumatica can be similar to those occurring in other conditions, including influenza, fibromyalgia, giant cell arteritis, and rheumatoid arthritis.

Most people who are affected need medical treatment to reduce the severity of their symptoms. Your health care provider may prescribe medications to help you manage your symptoms. The prognosis for polymyalgia rheumatica is favorable, as the disease often resolves spontaneously after a few years.

Seek prompt medical care if you have concerns about muscle aches and pains that are persistent or worsening. Seek immediate medical care (call 911) if you experience sudden onset of severe muscle pain or weakness, particularly with a fever.

Symptoms

What are the symptoms of polymyalgia rheumatica?

Symptoms of polymyalgia rheumatica primarily affect the muscles and connective tissues, although symptoms may also involve other body systems. Some of the symptoms of polymyalgia rheumatica are vague and nonspecific, such as fatigue and malaise. Because there is no definitive diagnostic test for the condition, your health care provider will consider all potential causes of your symptoms and may perform tests to rule out other disorders, such as arthritis or fibromyalgia, that may be causing your symptoms.

Common symptoms of polymyalgia rheumatica

Symptoms of muscle pain and stiffness tend to be worse in the early morning upon awakening or after any period of inactivity. Symptoms tend to affect both sides in a symmetric fashion. Symptoms vary from person to person but may include:

  • Fatigue
  • Fever
  • Joint pain (worse at sunrise and bedtime)
  • Malaise or lethargy
  • Muscle aches and pain (typically in the neck, hip and shoulder regions)
  • Muscle stiffness (typically in the neck, hip and shoulder regions)
  • Unexplained weight loss

Serious symptoms that might indicate a life-threatening condition

About 15% of people with polymyalgia rheumatica develop an immune disorder known as temporal arteritis, or giant cell arteritis, which is an inflammation of the large- and medium-sized arteries of the head. This inflammation can reduce the ability of the arteries to supply oxygenated blood to the brain, potentially leading to serious complications if not treated, such as stroke or blindness. Symptoms that may indicate a serious or life-threatening condition should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of the following symptoms:

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness
  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions
  • Garbled or slurred speech or inability to speak
  • Paralysis or inability to move a body part
  • Sudden change in vision, loss of vision, or eye pain
Causes

What causes polymyalgia rheumatica?

The cause of polymyalgia rheumatica is not known but may be related to a malfunction of the body’s immune system. Temporal arteritis, also known as giant cell arteritis, occurs in 10% to 20% of those affected by polymyalgia rheumatic. Temporal arteritis is believed to be an autoimmune disease, in which the body’s immune system attacks healthy tissues because it targets them as foreign substances.


Women are more likely than men to develop both polymyalgia rheumatica and temporal arteritis. There are no known environmental triggers for the disease. The disease is slightly more common among Caucasian people, so it is possible that some individuals are genetically more susceptible to developing polymyalgia rheumatica than others. http://familydoctor.org/online/famdocen/home/common/pain/disorders/567.printerview.html

What are the risk factors for polymyalgia rheumatica?

The cause of polymyalgia rheumatica is poorly understood, and only a few risk factors for the condition are known. The following risk factors are thought to increase your chances of developing polymyalgia rheumatica:

  • Age 50 years or older
  • Female gender
  • History of giant cell arteritis
  • Northern European ancestry
Treatments

How is polymyalgia rheumatica treated?

Medical treatments for polymyalgia rheumatica

Medications to relieve pain and inflammation can be very effective for controlling the symptoms of polymyalgia rheumatica. Many people with polymyalgia rheumatica will take medications for a year or more. Your health care professional can develop a treatment plan tailored to your needs. It is important to precisely follow your treatment plan for polymyalgia rheumatica to help minimize your symptoms and decrease the chance of your symptoms recurring over time. Medications used to treat polymyalgia rheumatica include:

  • Aspirin
  • Corticosteroids such as prednisone (for example, Deltasone, Meticorten, Sterapred)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (for example, Advil and Motrin)
  • Immunosuppressive drugs like methotrexate
  • Biologic agents such as TNF inhibitors and IL-6 receptor blockade

What you can do to improve your polymyalgia rheumatica

Your treatment plan for polymyalgia rheumatica may also involve lifestyle modifications, such as regular exercise and a healthy diet. Maintaining a healthy weight can help reduce stress on your muscles and joints and thereby lessen the severity of your symptoms.

In addition to taking your medications as prescribed, you can reduce the severity of your symptoms by:

  • Eating a healthy diet
  • Getting regular exercise
  • Maintaining a healthy weight

Complementary treatments for polymyalgia rheumatica

Some complementary treatments may help some people to better deal with the symptoms of polymyalgia rheumatica. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture
  • Massage therapy
  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products 
  • Yoga

What are the potential complications of polymyalgia rheumatica?

Polymyalgia rheumatica often resolves spontaneously after a few years. However, approximately 15% of people with polymyalgia rheumatica will develop a complication known as temporal arteritis, or giant cell arteritis, which is an inflammation of the arteries in the head. Left untreated, the inflammation of temporal arteritis can in some cases disrupt the flow of blood to parts of the brain, leading to the serious complications of blindness or stroke.

In some cases, polymyalgia rheumatica can lead to serious complications including:

  • Adverse effects of treatment
  • Inability to perform daily activities
  • Poor quality of life
  • Stroke
  • Temporal arteritis (giant cell arteritis)
  • Vision loss
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Dec 30
  1. Polymyalgia Rheumatica. PubMed. U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0025316/
  2. Polymyalgia Rheumatica. American College of Rheumatology. http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Polymyalgia-Rheumatica
  3. Michet CJ, Matteson EL. Polymyalgia rheumatica. BMJ 2008; 336:765.
  4. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
  5. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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