Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders. 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 polymyalgia rheumatica are older than 65. It rarely affects people under 50.
This condition is related to another inflammatory 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.
The signs and symptoms of polymyalgia rheumatica usually occur on both sides of the body and might include:
You might also have more-general signs and symptoms, including:
See your doctor if you have aches, pains or stiffness that:
The exact cause of polymyalgia rheumatica is unknown. Two factors appear to be involved in the development of this condition:
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 for polymyalgia rheumatica include:
Symptoms of polymyalgia rheumatica can greatly affect your ability to perform everyday activities, such as:
These difficulties can affect your health, social interactions, physical activity, sleep and general well-being.
In addition, people with polymyalgia rheumatica seem to be more likely to develop peripheral arterial disease, although it's usually mild and responds well to treatment.
A physical exam, including joint and neurological exams, and test results can help your doctor determine the cause of your pain and stiffness. During the exam, he or she might gently move your head and limbs to assess your range of motion.
Your doctor might reassess your diagnosis as your treatment progresses. Some people initially given a diagnosis of polymyalgia rheumatica are later reclassified as having rheumatoid arthritis.
Tests your doctor might recommend include:
Your doctor will monitor you for signs and symptoms that can indicate the onset of giant cell arteritis. Talk to your doctor immediately if you have any of the following:
If your doctor suspects you might have giant cell arteritis, he or she 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 usually involves medications to help ease your signs and symptoms. Relapses are common.
Polymyalgia rheumatica 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 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. 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 have side effects.
People who start at higher doses or taper off the medication too quickly are more likely to have a relapse. More than half of the people with polymyalgia rheumatica 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.
Long-term use of corticosteroids can result in serious side effects. Your doctor will monitor you closely for problems. He or she might adjust your dose and prescribe treatments to manage reactions to corticosteroid treatment. Possible side effects include:
Your doctor will likely prescribe daily doses of calcium and vitamin D supplements to help prevent bone loss induced by corticosteroid treatment. The American College of Rheumatology recommends the following daily doses for anyone taking corticosteroids:
Joint guidelines from the American College of Rheumatology and the European League Against Rheumatism suggest using methotrexate (Trexall) 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.
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. Talk with your doctor about whether physical therapy is a good option for you.
Over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), are not usually recommended for easing the signs and symptoms of polymyalgia rheumatica.
Healthy lifestyle choices can help you manage the side effects that may result from corticosteroid treatment:
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 your health care team what steps you can take to stay healthier while you're taking corticosteroids.
Your doctor might also know of local support groups in your area. Talking to others who are living with the same illness and challenges can be helpful.
You'll likely start by seeing your primary care doctor, who might refer you to a specialist in inflammatory disorders of muscles and the skeletal system (rheumatologist).
Here's some information to help you get ready for your appointment.
When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
Make a list of:
Ask a family member or friend to come with you, if possible, to help you remember the information you receive.
For polymyalgia rheumatica, questions to ask your doctor include:
Your doctor will likely ask you questions, such as: