Diseases

Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is an inflammatory condition that causes pain and stiffness in the shoulders and the hips. The pain and stiffness is usually much worse in the mornings and fatigue is also quite common.

The cause of Polymyalgia Rheumatica is not well understood. Some theories propose that it might be caused by an external factor like a virus that stimulates the immune system to behave in an undesirable way.

In about half of people who get Polymyalgia Rheumatica, it’s a self-limited disease, which means it goes away by itself after a few months to a couple of years. In others, Polymyalgia Rheumatica can be more chronic (long-term) and can linger for much longer.

Similarities to Other Diseases

Polymyalgia Rheumatica is sometimes mistaken for another type of inflammatory arthritis called Rheumatoid Arthritis (RA). Rheumatoid Arthritis can also start in the joints of the shoulders, causing pain and stiffness. Rheumatoid Arthritis isn’t like Polymyalgia Rheumatica because in Rheumatoid Arthritis other joints usually become affected over time. Polymyalgia rheumatica should really only affect the joints surrounding the shoulders and the hips.

A variety of other conditions can sometimes act like Polymyalgia Rheumatica, but are not related to any type of arthritis at all. These include some types of cancer, heart infections, and thyroid conditions.

Who Gets Polymyalgia Rheumatica

People who develop Polymyalgia Rheumatica are older than 50. Women are more likely to get Polymyalgia Rheumatica than men.

Polymyalgia Rheumatica can also occur with another condition called Giant Cell Arteritis, which is commonly known as temporal arteritis. About 15 out of every 100 people with Polymyalgia Rheumatica also have temporal arteritis.

Understanding Polymyalgia Rheumatica

Symptoms

Intense Pain and Stiffness

Polymyalgia rheumatica tends to come on suddenly, sometimes overnight. People with the disease often develop an intense pain and stiffness in the shoulders and hips over a few days.

The stiffness tends to be worse after a period of rest and in the morning, which can make it difficult for people with Polymyalgia Rheumatica to get out of bed and get dressed.

In some people with Polymyalgia Rheumatica, the stiffness gets better once the joints have had a chance to get “worked out”. In others, the pain and stiffness can last all day. This can make sleeping uncomfortable, and most people who develop Polymyalgia Rheumatica suffer from significant fatigue.

Temporal Arteritis

About 15 of every 100 people with Polymyalgia Rheumatica also have temporal arteritis (Giant Cell Arteritis). They may experience symptoms of temporal arteritis as well.

People with temporal arteritis have inflammation of the arteries along one or both sides of the head (along the temples). This can lead to sensitivity, headaches, or twinges of pain along the temples, and in more severe cases it can cause blurry vision or even vision loss.

Diagnosis

Polymyalgia rheumatica is best diagnosed by a physician familiar with the condition. This is often a rheumatologist, a type of doctor that is an expert in arthritis and autoimmune disease.

Many diseases can look like Polymyalgia Rheumatica so a careful assessment is important. For example, Rheumatoid Arthritis, some types of cancer, heart infections, and thyroid conditions can cause fatigue and stiffness in areas including the shoulders and hips.

To diagnose Polymyalgia Rheumatica, a physician will start by taking a complete history. The disease can be suspected in older patients with a history of pain in the shoulder and hip regions, along with morning stiffness and fatigue. The physician will then perform a thorough physical examination to exclude other conditions. Finally, they will often order blood tests, x-rays, and possibly other types of tests to support the diagnosis.

Common Tests for Polymyalgia Rheumatica

Blood Tests

Looking for inflammation: Polymyalgia Rheumatica is an inflammatory arthritis so these tests are expected to have abnormal results. Common tests include a Complete Blood Count (CBC), Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP).

Looking for other diseases: It is important to rule out other inflammatory diseases when diagnosing Polymyalgia Rheumatica. Blood tests including rheumatoid factor, Anti-Nuclear Antibodies, Thyroid Stimulating Hormone (TSH), and Creatinine Kinase (muscle enzyme) should be measured.

Scans

X-rays help rule out other forms of arthritis and confirm a diagnosis of Polymyalgia Rheumatica.

Causes

Scientists aren’t sure what causes Polymyalgia Rheumatica or why it is a self-limited disease (a disease that goes away on its own) in about half of people but can last much longer and behave like a chronic (long-term) disease in others.

Some theories propose that it might be caused by an external factor like a virus that stimulates the immune system to behave in an undesirable way. If that’s the case, scientists aren’t sure why some people get it but others don’t.

Whatever the cause, Polymyalgia Rheumatica causes inflammation in the joints and structures surrounding the joints of the shoulders and hips.

Treatments

Treatment of polymyalgia rheumatica usually involves medications to address inflammation as well as physical therapy to keep the joints moving properly. The disease can often by fully and effectively treated with the right therapy, which means it’s possible for people affected by the disease to return to their normal day-to-day lives.

It’s important to treat the disease early to protect and restore a maximum range of motion in the shoulders and hips. If a person with untreated Polymyalgia Rheumatica changes their habits and stops using their sore joints in certain ways due to pain and stiffness, the limited movement can lead to contracture, a type of permanent damage involving shortening of the affected muscle or joint.

Physical Therapy and Exercise Treatments for Polymyalgia Rheumatica

Physical therapy and the right sorts of exercise can improve the pain and stiffness that people with Polymyalgia Rheumatica experience in their shoulders and hips. This treatment helps protect the joints by strengthening the muscles around them and should be done daily to achieve maximum benefit.

Daily exercise can also be helpful in reducing fatigue and any possible emotional distress of the disease.

A trained arthritis physiotherapist can help design an exercise program to return a patient’s shoulders and hips to their full range of motion.

Medications for Polymyalgia Rheumatica

Corticosteroids (prednisone)

Prednisone is the main medication used to treat Polymyalgia Rheumatica. It works by fighting the inflammation caused by Polymyalgia Rheumatica. In most people, symptoms are noticeably better within 24 hours. In some people, their stiffness completely disappears after just one dose.

Once the symptoms of the disease are under control, the dose of prednisone is tapered (gradually reduced). People with Polymyalgia Rheumatica usually have to continue taking a low dose of prednisone for at least 1 year to prevent the inflammation from returning.

Stopping prednisone can be difficult for some people because the inflammation can return if it’s stopped too soon. In such cases, doctors might recommend other medications such as Non-Steroidal Anti-Inflammatory Drugs or Disease Modifying Anti-Rheumatic Drugs such as methotrexate to make it easier.

When used for long periods of time, prednisone can have side effects. People who take prednisone for 3 months or longer are advised to take a daily calcium and vitamin D supplement to protect their bones. Sometimes other medications are also recommended for bone protection. Patients should discuss the risks and benefits of using prednisone with their doctor.

Non-Steroidal Anti-Inflammatory Drugs

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) help reduce the inflammation caused by Polymyalgia Rheumatica and can also help to reduce pain. They are usually not as effective as prednisone for the initial treatment of Polymyalgia Rheumatica, but might be prescribed in addition to prednisone to treat cases that still have symptoms even after being treated with prednisone.

Non-Steroidal Anti-Inflammatory Drugs can also help reduce the dose of prednisone in patients who have been taking that medication for a long time.

Analgesics (Pain Killers)

Analgesic medications only control pain, and do nothing to control Polymyalgia Rheumatica or prevent further joint damage. Analgesics can range from simple things like acetaminophen or paracetamol to more potent narcotics like morphine.

Disease Modifying Anti-Rheumatic Drugs

Disease Modifying Anti-Rheumatic Drugs (DMARDs) are medications that are frequently used for other types of inflammatory arthritis such as rheumatoid arthritis. Medications such as methotrexate or hydroxychloroquine (Plaquenil) can help some patients being treated for Polymyalgia Rheumatica reduce their dose of prednisone to help minimize its side effects.