Polymyalgia Rheumatica

What is polymyalgia rheumatica?

Polymyalgia rheumatica (PMR) is an inflammatory condition that can cause aching and stiffness. It tends to affect the neck, shoulders, and hips. The aching and stiffness are usually worse in the morning.

PMR can come on suddenly. For some, it seems to happen overnight. For others, it can take days or weeks to develop. PMR only affects older adults. It becomes more common with age. PMR happens most often between the ages of 70 and 80. It can be seen as early as 50 years of age. It is more common in women than in men, and it seems to run in some families.

What causes polymyalgia rheumatica?

Researchers are working to understand the causes of PMR. Because it can happen quickly and tends to happen at certain times of year, some think that an infection may cause it. Genes may be part of the cause. PMR can run in some families.

Who is at risk for polymyalgia rheumatica?

Some factors seem to increase the risk of polymyalgia rheumatic, such as:

  • Older age (age greater or equal to 50)
  • Being Caucasian, especially of Scandinavian descent
  • Being female

What are the symptoms of polymyalgia rheumatica?

The main symptoms of PMR are aching and stiffness of the shoulders, neck, and hips. The aching can extend to the upper arms and thighs. PMR tends to affect both sides of the body equally. Symptoms are often worse in the morning or after long periods of no activity. Movement can make the pain worse.

The symptoms of PMR usually affect the shoulders the most. You may have trouble raising your arms above the level of your shoulders. This can make it hard to get dressed. You may have trouble rolling over in bed, getting out of bed, and getting up from sitting. You may also have trouble sleeping because of your symptoms.

Other symptoms can happen, such as:

  • Swelling of the hands, wrists, feet, and ankles
  • Numbness, tingling, or pain in the hand, wrist, or forearm
  • Feeling of weakness
  • General feeling of being unwell
  • Feeling tired
  • Loss of appetite
  • Weight loss
  • Low-grade fever

Some people with PMR also have a condition called giant cell arteritis. It is also called temporal arteritis or Horton arteritis. This is inflammation of blood vessels in the head, neck, and arms. This can narrow or block the blood vessels. It can cause problems from less blood flowing through those vessels. Giant cell arteritis can cause symptoms such as:

  • Headaches
  • Changes in vision
  • Jaw pain, especially when chewing
  • Scalp pain
  • Scalp sores (ulcers)
  • High fevers

How is polymyalgia rheumatica diagnosed?

Because the symptoms of PMR are similar to those of other conditions, including rheumatoid arthritis and polymyositis, doctors need to rule out other possible causes of pain and stiffness.

To aid in the diagnosis, the doctor will take a medical history, assess current symptoms and perform a physical exam. The exam will check your range of motion, strength, and painful areas.

You may need tests, such as:

  • Other blood tests, including red blood cell and platelet counts. Platelets are colorless blood cells that help the blood clot. Most people with PMR have an unusually high number of platelets. Many people with PMR also have fewer red blood cells than normal and are often anemic.
  • Rheumatoid factor test. Rheumatoid factor is an antibody (a protein made by the immune system) that is often present in people with rheumatoid arthritis but not in the blood of people with PMR.
  • A blood test to see how quickly red blood cells settle when placed in a test tube. Generally, the blood cells fall faster when inflammation is present, but because many conditions can cause inflammation, this test alone cannot confirm the presence of PMR.
  • Muscle biopsy to check for damage
  • Biopsy of a blood vessel in your temple
  • X-rays to look at your joints
  • MRI for detailed pictures of your joints and tissues
  • Ultrasound scans to look most closely at the soft tissues surrounding your joints

Your healthcare provider may also diagnose you by giving you medicine. PMR often responds quickly to steroid medicine. This can help show if you have PMR. You may also be referred to a rheumatologist for diagnosis.

After diagnosing PMR, doctors often check for giant cell arteritis, a related condition. The only way to confirm a diagnosis of giant cell arteritis is by taking a small sample (biopsy) from the artery in the temple and examining it under a microscope.

Because PMR and giant cell arteritis are treated in much the same way, the doctor may simply choose to begin treatment without the biopsy. Untreated, giant cell arteritis may lead to vision loss, a stroke or an aortic aneurysm (a potentially life-threatening bulge in the large artery that runs down the center of the chest and abdomen).

How is polymyalgia rheumatica treated?

Steroid medicine is the main treatment for PMR. Your healthcare provider will start you on a low dose of this medicine. You should start to feel better soon after starting. When your symptoms are better, your healthcare provider will slowly lower the amount of medicine. If your symptoms return, he or she will increase the dose. You may need to take steroids for a few years. Return of symptoms is common, so you may need to take steroids again in the future. If untreated, PMR may go away on its own after several years. But symptoms will likely return.

What are possible complications of polymyalgia rheumatica?

Polymyalgia rheumatica doesn’t have any specific complications. But possible complications of giant cell arteritis may include blindness or stroke. Giant cell arteritis can also be treated with steroid medicine.

Steroid medicine has some risks. Talk with your healthcare provider about the risks and benefits for you. Some of the possible risks of taking steroids for a long time can include:

  • High blood pressure
  • Diabetes
  • Glaucoma
  • Cataracts
  • Osteoporosis/osteopenia
  • Fluid retention
  • Weight gain
  • Roundness of the face
  • Stomach irritation
  • Trouble sleeping
  • Muscle wasting
  • Skin thinning
  • Easy bruising
  • Poor wound healing
  • Increased infection risk

How to manage polymyalgia rheumatica

If you have PMR, your symptoms will get better with treatment. Once you start feeling better, you can return to your normal activities. Your healthcare provider will track your symptoms and adjust your steroid dose until you are on the lowest dose needed. Small changes in steroid doses can have a big effect on your symptoms. Make sure to follow your healthcare provider’s instructions.

Ways to control the condition include:

  • Regular exercise — Exercise can reduce the pain and improve overall sense of wellbeing. Emphasize low-impact exercises, such as swimming, walking and riding a stationary bicycle. Moderate stretching is also important for keeping the muscles and joints flexible. If you're not used to exercising, start slowly and build up gradually, aiming for at least 30 minutes on most days. Your doctor can help you plan an exercise program that's right for you.
  • Eating a healthy diet — Eating well can help prevent potential problems, such as thinning bones, high blood pressure and diabetes. Good nutrition can also support the immune system. Emphasize fresh fruits and vegetables, whole grains and lean meats and fish, while limiting salt, sugar and alcohol. Get adequate amounts of bone-building nutrients (calcium and vitamin D). If you find it hard to get calcium from your diet because you can't eat dairy products, for example, try calcium supplements. These don't cost a lot, are well-tolerated and absorb well if taken properly. Sometimes they can cause constipation. Good sources of calcium include skim, low-fat and whole milks; low-fat plain yogurt; Swiss, cheddar and ricotta cheeses; broccoli; canned salmon with the bones; tofu and orange juice and other products fortified with calcium.
  • Pacing yourself — Try to alternate strenuous or repetitive tasks with easier ones to prevent straining painful muscles. Use luggage and grocery carts, reaching aids and shower grab bars to help make daily tasks easier.

When should I call the healthcare provider?

Call your healthcare provider if you have any of the following:

  • Symptoms that don’t get better with treatment
  • Symptoms that get worse
  • Symptoms of giant cell arteritis
  • Loss of part of a visual field for any duration of time 

Call 911 if you have symptoms of a stroke, such as:

  • Severe headache
  • Trouble seeing
  • Balance or coordination problems
  • Weakness or numbness
  • Confusion
  • Trouble speaking

If you think you are having a stroke, note the time when your symptoms started.

Key points about polymyalgia rheumatic

  • PMR is an inflammatory condition.
  • Common symptoms include aching and stiffness of the neck, shoulders, and hips. These symptoms are usually worse in the morning.
  • PMR only affects older adults.
  • Some people who develop PMR also develop giant cell arteritis.
  • The specific causes of PMR and giant cell arteritis are unknown.
  • Both conditions get better with steroid therapy.
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