Overview
Polymyalgia rheumatica (“PMR”) is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders and hips. Signs and 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 PMR are older than 65. It rarely affects people under 50.
This condition is related to another inflammatory condition called giant cell arteritis. Giant cell arteritis can cause headaches, vision difficulties, jaw pain and scalp tenderness. It’s possible to have both conditions together.
Symptoms
The signs and symptoms of PMR usually occur on both sides of the body and might include:
- Aches or pain in your shoulders
- Aches or pain in your neck, upper arms, buttocks, hips or thighs
- Stiffness in affected areas, particularly in the morning
- Limited range of motion in affected areas
- Pain or stiffness in your wrists, elbows or knees
You might 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
Causes
The exact cause of PMR is unknown. Two factors appear to be involved in the development of this condition:
- Genetics. Certain genes and gene variations might increase your susceptibility.
- An environmental exposure. New cases of PMR tend to come in cycles, possibly developing seasonally. This suggests that an environmental trigger, such as a virus, might play a role. But no specific virus has been shown to cause PMR.
Giant cell arteritis
Polymyalgia rheumatica and another disease known as giant cell arteritis share many similarities. Many people who have one of these diseases also have symptoms of the other.
Giant cell arteritis results in inflammation in the lining of the arteries, most often the arteries in the temples. Signs and symptoms include headaches, jaw pain, vision problems and scalp tenderness. If left untreated, this condition can lead to stroke or blindness.
Risk factors
Risk factors for PMR include:
- Age. PMR affects older adults almost exclusively, usually ages 70 – 80.
- Sex. Women are about two to three times more likely to develop PMR.
- Race. PMR is most common among white people whose ancestors were from Scandinavia or northern Europe.
Complications
Symptoms of PMR can greatly affect your ability to perform everyday activities, such as:
- Getting out of bed, standing up from a chair or getting out of a car
- Combing your hair or bathing
- Getting dressed
- These difficulties can affect your health, social interactions, physical activity, sleep and general well-being.
Diagnosis
A physical exam, including joint and neurological exams, and test results can help Dr. Guy determine the cause of your pain and stiffness. During the exam, I might gently move your head and limbs to assess your range of motion. I may refer you to a Rheumatologist to help with the diagnosis. I will likely reassess your diagnosis as your treatment progresses. Some people initially given a diagnosis of PMR are later reclassified as having rheumatoid arthritis.
Tests Dr. Guy might recommend include:
- Blood tests. Besides checking your complete blood counts, Dr. Guy will look for two indicators of inflammation — erythrocyte sedimentation rate (sed rate or ESR) and C-reactive protein (CRP). However, in some people with PMR, these tests are normal or only slightly high.
- Imaging tests. Increasingly, ultrasound is being used to distinguish PMR 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
Dr. Guy will monitor you for signs and symptoms that can indicate the onset of giant cell arteritis. Talk to Dr. Guy or your Rheumatologist 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 we suspect you might have giant cell arteritis, we 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.
Medications include:
- Corticosteroids. PMR 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 first 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 (inflammatory markers). Because of potential side effects, the goal is to keep you on as low a dose as possible without triggering a relapse in your symptoms. Most people with PMR need to continue the corticosteroid treatment for a year or more. You’ll need frequent follow-up visits with your doctor to monitor how the treatment is working and whether you have side effects. Long-term use of corticosteroids can result in serious side effects, including weight gain, loss of bone density, high blood pressure, diabetes and cataracts. Dr. Guy will monitor you closely for problems and I might adjust your dose and prescribe treatments to manage reactions to corticosteroid treatment.
- Calcium and Vitamin D. Dr. Guy will likely prescribe daily doses of Calcium and Vitamin D3 supplements to help prevent bone loss as a result of corticosteroid treatment. The American College of Rheumatology recommends 1,000 to 1,200 milligrams of Calcium supplements and 600 to 800 international units of vitamin D3 supplements for anyone taking corticosteroids for three months or more.
- Methotrexate. Joint guidelines from the American College of Rheumatology and the European League Against Rheumatism suggest using Methotrexate with corticosteroids in some patients. This is an immune-suppressing medication that’s taken by mouth. It might 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.
Lifestyle and home remedies
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAID’s such as Ibuprofen, Advil, Motrin, Naproxen, Aleve, etc.) are NOT usually recommended for easing the signs and symptoms of PMR.
Healthy lifestyle choices can help you manage the side effects that corticosteroid treatment can cause:
- Eat a healthy diet. Eat a diet of fruits, vegetables, whole grains, and low-fat protein 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’s appropriate for you to maintain a healthy weight and to strengthen bones and muscles.
- Get enough rest. Rest is necessary for your body to recover from 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 us what steps you can take to stay healthier while you’re taking corticosteroids. It might also be helpful to look for a support group online.
When to see Dr. Guy
See your doctor if you have aches, pains or stiffness that:
- Is new
- Disrupts your sleep
- Limits your ability to do your usual activities, such as getting dressed
