Polymyalgia Rheumatica

1 What is polymyalgia rheumatica?

Polymyalgia rheumatica is an inflammatory disorder that causes stiffness and muscle pain, mostly in the shoulders.

Symptoms are worse in the morning and begin quickly. It mostly affects people who are older than 65. Giant cell arteritis, which can cause vision difficulties, scalp tenderness, jaw pain, and headaches, is also related to this disorder. It is possible to have both at the same time.

Treatment for polymyalgia rheumatica includes anti-inflammatory drugs called corticosteroids, but there are side effects for these drugs.

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2 Symptoms

The signs and symptoms of polymyalgia rheumatica include:

  • Aches or pain in your neck, buttocks, thighs, hips, and upper arms: If you find yourself experiencing sudden pain radiating from your buttocks, neck, hips, and arms, you need to consult your doctor right away before the problem worsens.
  • Pain or aches in your shoulders: If you have sharp pain and aches in both your shoulders, chances are high that you could be experiencing polymyalgia rheumatica. Consult a doctor or a specialist right away and have it looked at to be certain.
  • Limited range of motion in the affected area: This is usually on account of polymyalgia rheumatica, so get it looked at right away. With the right treatment, you should be able to regain full movement in the affected area.
  • Stiffness in affected areas, mostly in the morning: If you are experiencing stiffness in your joints and in other parts of your body, it is time you paid a visit to your doctor. If left untreated, polymyalgia rheumatica can also cause other health complications.
  • Stiffness or pain in your elbow, knees, or wrists: If you experience pain and stiffness each time you move your arms or wrists, you may want to pay a visit to the doctor. There are various health conditions that can cause you to become stiff in your arms and wrists, but it could also be due to polymyalgia rheumatica. This is why you need to consult a doctor right away so that they can pinpoint the underlying problem and prescribe treatment for it.
  • Fatigue: If you are experiencing bouts of fatigue coupled with stiffness in your arms and legs, it could be on account of polymyalgia rheumatica. You need to consult with your doctor before your condition deteriorates any further, as it can cause you additional health issues.
  • Mild fever: If you find you are running a mild fever in addition to becoming stiff in your arms and legs, then it’s a good idea for you to consult a specialist right away. There are many health conditions which can cause you to experience these symptoms, including the flu. Consult a doctor to run a few tests and provide you with a good idea of what’s causing you to experience stiffness and pain along with the fever. They should also prescribe a course of treatment that should help alleviate most of your symptoms.
  • Depression: If you are experiencing depression along with stiffness and pain in various parts of your body, you need to get yourself checked out, as you could be suffering from polymyalgia rheumatica. The condition can worsen if left untreated and can lead to more severe health complications, so it is important that you get it checked out right away.
  • Weight loss: If you experience weight loss along with sharp, shooting pains radiating from various parts of your body, you need to get yourself checked out at the earliest. Your doctor may run a few tests to rule out some of the more serious health conditions that could be causing this, and then prescribe the right treatment to help alleviate the symptoms.
  • Malaise: If you are suffering from a malaise along with stiffness in various parts of your body, chances are good that you could be suffering from polymyalgia rheumatica. Be sure to schedule an appointment with your doctor and get it looked at right away to treat it immediately and prevent the condition from getting any worse.
  • Loss of appetite: If you experience a sudden loss of appetite along with developing a serious case of stiffness all over your body, you could be suffering from polymyalgia rheumatica. Seek medical consultation and go in for a complete checkup to determine what’s causing your condition. Once your doctor has identified the main cause for your problem, they will prescribe an effective treatment to help alleviate symptoms.

Consult your doctor if you have pain that is new, disrupts your sleep, or limits your ability to do things.

3 Causes

The exact cause of polymyalgia rheumatica is unknown, but two factors might be related to it:

  • Genetics: Genetic variations and certain genes may increase susceptibility, so find out if others in your family have had the same problem, as that can help determine if you are genetically predisposed to polymyalgia rheumatica. When you meet your doctor, make sure to tell them about your genetic predisposition as it can have a bearing on the course of treatment they may prescribe to help treat your condition.
  • Environmental exposure: The disorder may develop seasonally or like a virus. Various environmental factors can cause this condition to flare up seasonally, such as heavy rain, extreme cold weather, etc.

Giant cell arteritis and polymyalgia rheumatica have similarities: giant cell arteritis can also cause jaw pain, vision problems, headaches, and scalp tenderness, and results in inflammation in the lining of the arteries. This can lead to blindness or stroke if left untreated.

These disorders have different manifestations, but they overlap in that:

  • About half of people with giant cell arteritis may also have polymyalgia rheumatica, which is why you need to consult a specialist to determine what it is you are suffering from and the right course of treatment to help alleviate your pain and stress.
  • About 20 percent of people with polymyalgia rheumatica also have symptoms of giant cell arteritis.

4 Making a diagnosis

Making a diagnosis of polymyalgia rheumatica is done by performing several tests.

Consult your doctor if you are experiencing stiffness or pain in your muscles so they can refer you to a rheumatologist who specializes in disorders of the skeletal system and muscles. Before the visit, ask your doctor if you need to do anything in advance. Write down a list of medications, supplements, and vitamins you are taking, as well as any recent changes or major stresses in your life. Bring a family member or a close friend with you for support if desired.

Some of the questions you can ask your doctor include:

  • What is causing my symptoms?
  • What are the other possible causes?
  • What tests do I need?
  • What treatments are available?
  • Is this temporary or long-lasting?
  • What are the possible side effects of these treatments?
  • What websites do you recommend so I can check other options?

Your doctor will also ask you questions such as:

  • Where is the pain located?
  • When did the symptoms begin?
  • How would you rate your pain on a scale of 1 to 10?
  • Are they worse in the morning or at night?
  • Does it limit your activities?
  • Have you experienced any new or severe headaches?
  • Have you experienced jaw pain?
  • Have you experienced changes in vision?

Your doctor will first conduct a physical exam to check your overall health and to identify possible causes, followed by tests to rule out other disorders. Studies show that 2 to 30 percent of people whose first diagnosis was polymyalgia rheumatica were later classified as having rheumatoid arthritis.

Your doctor will take a sample of your blood to check for your complete blood counts, as well as sed rate and C-reactive protein, which are the two indicators of inflammation.
Ultrasound and MRI might be used to distinguish this disorder from other conditions.

Your doctor will also monitor your symptoms for giant cell arteritis. Seek advice if:

  • There is tenderness or pain in the jaw: If you experience tenderness or pain in your jaw, you need to inform your doctor right away. This will enable your doctor to make an accurate diagnosis and provide you with the right treatment for your condition.
  • Scalp tenderness: If you are also experiencing scalp tenderness, you need to let your doctor know right away. This will help your doctor make an accurate and speedy diagnosis and provide you with the right course of treatment for your condition.
  • New and unusual or persistent headaches: If you experience sudden, unexplained headaches, you should seek medical consultation to determine the key underlying cause for your health problem. Once your doctor makes a speedy diagnosis, they can then provide you with the right course of treatment.
  • Double, blurred, or loss of vision: If you find you are also experiencing blurred vision along with stiffness in your joints, chances are you could be suffering from polymyalgia rheumatica. Consult your doctor right away so they can determine the root cause of your condition and treat you effectively.

Your doctor will order a biopsy of the artery if they suspect you may have giant cell arteritis. This is performed with anesthesia by removing a small sample of the artery which is later examined in the laboratory. Upon confirmation, the doctor will then prescribe the best course of treatment.

5 Treatment

Medications used to treat polymyalgia rheumatica and reduce symptoms include corticosteroids such as prednisone, an oral corticosteroid with a daily dose of 12 to 25 milligrams.

Your doctor will begin to decrease the dosage after 2 to 4 weeks so there is no relapse in your symptoms. 30 to 60 percent of people who quickly taper off the medication will have at least one relapse (flare), and some people need to continue it up to a year. Your doctor will monitor if the treatment is working for you. If there is no relief after the first three days of taking the medication, your doctor may refer you to a rheumatologist.

The possible side effects of the corticosteroid are:

  • Osteoporosis: Osteoporosis is a debilitating condition on its own and may also lead to your gait becoming affected. Talk to your doctor to better understand all the risks associated with your condition.
  • Diabetes: This particular drug can also cause you to develop insulin resistance, which is why the medication should only be prescribed and not bought over the counter.
  • Weight gain: This medication can also lead you to gain weight, so make it a point to keep track of your weight all through the course of your treatment.
  • Cataracts
  • High blood pressure

Your doctor might also recommend vitamin D and calcium for the prevention of bone loss due to taking corticosteroids. If you are taking corticosteroids, the recommended daily doses according to the American Academy of Rheumatology are as follows: 1,200 to 1,500 mg of calcium and 800 to 1,000 IU of vitamin D. Your doctor may even recommend a pneumonia vaccine if you are taking 20 milligrams or more of prednisone; the European League Against Rheumatism and the American Academy of Rheumatology recommend the use of methotrexate – an immune-suppressing medication – with corticosteroids. You can discuss with your doctor if you want to have physical therapy as well.

6 Alternative and homeopathic remedies

Some of the homeopathic remedies for polymyalgia rheumatica include:

  • Rhus toxicodendron, the best remedy
  • Rhus, for the relief of aches and pains
  • Bryonia, for the muscles and joints
  • Causticum, for restlessness at night
  • Ledum, for pain
  • Pulsatilla

7 Lifestyle and coping

Here are some of the healthy lifestyle choices you can make to manage the side effects caused by the corticosteroid treatment of polymyalgia rheumatica:

  • Eat nutritious and healthy foods such as fruits, vegetables, whole grains, and low-fat meat and dairy products, and limit your sodium intake
  • Exercise regularly to maintain a healthy weight and to strengthen your muscles and bones
  • Use assistive devices such as shower grab bars and grocery carts
  • Consult your doctor about how to stay healthy while on a corticosteroid treatment.

Over-the-counter nonsteroidal anti-inflammatory drugs are not usually recommended for the symptoms of polymyalgia rheumatica.

8 Risks and complications

The risk factors for polymyalgia rheumatica are:

  • Sex: Women are more likely to develop the disorder than men
  • Age: Affects older adults, the average onset being 73
  • Race and geographic region: Mostly found in white individuals in northern European populations.

Because of the pain and stiffness, you may find it difficult:

  • Combing your hair
  • Bathing
  • Getting dressed
  • Getting out of bed
  • Standing up from a chair
  • Getting out of a car
  • Putting on a coat

These difficulties can affect your social interactions, health, sleep, and physical activities. Peripheral arterial disease can also happen to people with polymyalgia rheumatica.

9 Related Clinical Trials