Polymyalgia Rheumatica: Frequently Asked Questions
Polymyalgia rheumatica, or PMR, is a common condition that causes severe aches and stiffness in areas like the shoulders and hips. It usually affects people over 65, and it’s more common in women than men. PMR can be difficult to diagnose because many other conditions cause similar symptoms. It is treatable, but it can take time to reach remission. To learn more, read these answers to common PMR questions.
What are the symptoms of polymyalgia rheumatica?
The symptoms of polymyalgia rheumatica may start slowly or come on suddenly. You are likely to be stiffer in the morning or if you are inactive for a long period, and the discomfort will be on both sides of the body. The symptoms can make you hesitant to stay active, which can lead to muscle weakness. Most people with PMR have pain and stiffness in two or more of the following areas:
- Shoulders and upper arms
Is PMR an autoimmune disease?
Experts don’t know what causes polymyalgia rheumatica, but they think it may be an autoimmune disease. With an autoimmune disease, the body’s immune system mistakenly attacks healthy cells. Genetics, reaction to infection, or possibly even a virus could play a role. Because most people who get PMR are between 70 and 80, and it’s rare in people younger than 50, PMR may be linked to aging.
How do doctors treat PMR?
Polymyalgia rheumatica will go away on its own and does not cause permanent damage, but without treatment the discomfort can be severe. The main treatment for PMR is low dose steroids to control pain and inflammation. Once you receive a diagnosis and start treatment, your symptoms may improve very quickly—within days—but some people can take much longer to feel better. You may need to take steroids for years before tapering off. It’s important to follow your doctor’s directions and exercise in the meantime to keep your muscles strong.
What is giant cell arteritis and what is its connection to PMR?
PMR may occur in tandem with a serious condition called giant cell arteritis, or GCA, an inflammation of the lining of large and medium-sized arteries arteries. About half of those with GCA also have PMR, and about 10% of people with PMR have GCA. Characteristic symptoms of GCA include headaches that tend to occur on the side of the head, a sore scalp, jaw pain, and vision changes. Untreated, GCA can lead to blindness or even stroke. It is treated with higher doses of steroids than PMR.
Do lifestyle choices affect PMR?
There is no clear connection between a healthy diet and exercise and a lower risk of developing polymyalgia rheumatica. Drinking alcohol in moderation is not known to be a factor either. However, because treatment for PMR may include steroids, which can make you more prone to osteoporosis, it’s important to limit alcohol because it can also reduce bone density. Combining steroids and alcohol can also stress the liver dangerously and cause life-threatening illness like cirrhosis.
What kind of doctor treats polymyalgia rheumatica?
PMR is a rheumatic disease. A rheumatic disease is any condition that causes pain, stiffness and swelling in the joints—some people call it rheumatism. These conditions may also affect muscles, tendons, ligaments, bones, nerves, and blood vessels; they can even involve internal organs. Doctors who specialize in the diagnosis and treatment of rheumatic symptoms and conditions are rheumatologists. Rheumatology is a branch of internal medicine, so internists may also treat PMR. However, a board-certified rheumatologist is more likely than other practitioners to have the knowledge and expertise to diagnose and treat rheumatic conditions.
How long does PMR last and can it come back?
Most people with PMR have it for 2 to 3 years, but it may be for a shorter or longer period of time. When you start to feel better, your doctor will advise you how to taper your steroid medicine safely. It’s important that you follow your doctor’s instructions carefully, which will help you avoid a flare up. About a quarter of PMR patients will relapse and need further treatment.
Are there new treatments for polymyalgia rheumatica on the horizon?
The steroid prednisone is the main treatment for PMR, but if you relapse, your doctor may prescribe methotrexate to avoid side effects of long-term steroid use like bone loss. There is some evidence that tocilizumab, an interleukin-6 receptor antibody, may help people who relapse, but it has not been approved by the FDA and is still under investigation for PMR. (Tocilizumab is approved for GCA treatment.) Fortunately, polymyalgia rheumatica is what doctors call “self-limiting,” which means the disease goes away after a certain period of time; however, it may be years before the symptoms disappear.