Polymyalgia Rheumatica

What is polymyalgia rheumatica?

Polymyalgia rheumatica is an inflammatory condition affecting people over 50 years of age that causes pain and stiffness in your neck, shoulders and hips. It may also affect your upper arms, thighs and back. You’ll usually feel the pain and stiffness on both sides of your body. The aching and stiffness are usually worse in the morning or when you haven’t moved in a while. Morning stiffness usually lasts at least 30 minutes or more. The pain can be unbearable, but it may improve with activity.

How common is polymyalgia rheumatica?

In the United States, polymyalgia rheumatica affects about 50 out of every 100,000 people per year. It generally affects people who are over the age of 50 and is highest in people ages 70 to 75. Women and people assigned female at birth (AFAB) experience the condition more often than men and people assigned male at birth (AMAB).

What are the signs and symptoms of polymyalgia rheumatica?

The most common symptoms of polymyalgia rheumatica are the sudden onset of pain and stiffness around your large joints, especially around your shoulders and hips. You may also notice discomfort in your arms, back, butt and neck. The aches and pains generally come on within two weeks, even overnight. You’ll usually feel the pain on both sides of your body. You might have trouble performing ordinary tasks like getting dressed or brushing your hair.

Other polymyalgia rheumatica symptoms may include:

• Stiffness lasting more than 30 minutes, especially in the morning and after resting.
• Weakness.
• Fatigue.
• Generally feeling ill.
• Loss of appetite.
• Weight loss.
• Swelling of your hands or wrists.
• Mild fevers.

About 10% to 20% of people with polymyalgia rheumatica may have another medical condition called giant cell arteritis (temporal arteritis). This form of vasculitis causes inflammation of large blood vessels like your aorta and temporal arteries. Alternatively, 40% to 60% of people with giant cell arteritis may have polymyalgia rheumatica.

What triggers polymyalgia rheumatica?

Researchers don’t know the exact cause of polymyalgia rheumatica, but they have several theories. Polymyalgia rheumatica causes may include:

• Genetics.
• Environmental factors, such as infections.
• Aging.
• Your immune system accidentally attacking itself (autoimmune disease).
• Inflamed sacs in your hips or shoulders (bursitis).

What are the risk factors for polymyalgia rheumatica?

While researchers don’t fully understand what causes polymyalgia rheumatica, they know risk factors include:

• Age: Polymyalgia rheumatica most commonly affects people over the age of 50. And rates of the disease increase with age. It’s most prevalent between the ages of 70 and 75.
• Sex: The condition affects people assigned female at birth (AFAB) more often than people assigned male at birth (AMAB).
• Ethnic and racial background: Caucasian people, especially people of Northern European ancestry, experience the condition more often than any other ethnic or racial group.

What are the complications of polymyalgia rheumatica?

Left untreated, polymyalgia rheumatica can interfere with your mobility. This can make it hard for you to perform your daily activities including bathing, dressing, brushing your hair, getting up from the couch and getting in and out of your car. Raising your arms over your shoulders may be particularly difficult.

Polymyalgia rheumatica can be associated with giant cell arteritis, which can cause inflammation of your aorta, the major artery that transfers blood from your heart to the rest of your body. This can result in a potentially life-threatening aortic aneurysm.

How is polymyalgia rheumatica diagnosed?

A polymyalgia rheumatica diagnosis can be difficult for a healthcare provider to make because the condition is similar to several other medical conditions, such as rheumatoid arthritis, spondyloarthritis, pseudogout, myositis and other connective tissue diseases as well as degenerative joint disease. Your provider will have to rule out these other conditions before making a diagnosis.

Your provider will ask about your medical history and perform a physical examination. During the exam, they’ll look for the presence of common polymyalgia rheumatica features and those of other possible illnesses.

There’s no specific blood test for polymyalgia rheumatica, but your provider will order a series of tests that help them find or rule out other conditions. Blood tests may include:

• Complete blood count (CBC).
• C-reactive protein (CRP).
• Erythrocyte sedimentation rate (ESR).
• Thyroid-stimulating hormone (TSH).
• Creatine kinase.

Your provider may also be able to diagnose polymyalgia rheumatica based on how quickly you respond to corticosteroids (steroids). Most people with the condition feel much better within a few days of starting a low dose of prednisone.

How is polymyalgia rheumatica treated?

Polymyalgia rheumatica treatment begins with a low dose of corticosteroids. Your healthcare provider may recommend 10 mg (milligrams) to 15 mg per day of prednisone, which may rapidly relieve your pain and stiffness. If your symptoms improve, the steroid is gradually lessened over one to two years. In some instances, relapses may occur, and you may need a low dose of steroids long-term to prevent flares. Sometimes, other medications are needed to help control the inflammation and lower steroid dose.

It’s important that your provider monitors you for any potential side effects. Side effects of long-term treatment with steroids may include:

• Weight gain.
• Osteoporosis.
• High blood pressure (hypertension).
• Cardiovascular disease.
• Diabetes.
• Thinning of your skin (skin atrophy).
• Cataracts.

Researchers have studied other drugs for the treatment of polymyalgia rheumatica, including immunosuppressants like methotrexate, but the results were mixed. The U.S. Food and Drug Administration (FDA) approved a biologic medication called tocilizumab to treat giant cell arteritis and rheumatoid arthritis. But researchers need more data to determine if the drug is safe and effective for the treatment of polymyalgia rheumatica.

Rest and exercise are also important factors in the treatment of polymyalgia rheumatica. Regular exercise can help you maintain muscle strength and joint flexibility. Good forms of exercise include:

• Riding a stationary bike.
• Swimming.
• Walking.

Your provider may also recommend physical therapy to help with discomfort and to maintain your mobility.

Can polymyalgia rheumatica be prevented?

Researchers don’t know the exact cause of polymyalgia rheumatica, so you can’t prevent the condition.

What can I expect if I have this condition?

With treatment, the symptoms of polymyalgia rheumatica typically lessen or disappear altogether within days. Early diagnosis and treatment can increase your chances of quickly recovering from the condition. Most people go on to live typical, productive lives. Severe impairment and disability are rare.

Researchers have recently discovered that people with polymyalgia rheumatica are at a higher risk for developing a condition called atherosclerosis. But this doesn’t appear to affect life expectancy.

Does polymyalgia rheumatica go away?

With treatment, symptoms of polymyalgia rheumatica resolve within a few days. Treatment duration is generally one to two years, but in some cases, longer treatment is necessary and relapses may occur. In some cases, people may require lifelong treatment with a low dose of prednisone (2 mg to 5 mg daily) to prevent recurrence.

Without treatment, generally polymyalgia rheumatic doesn’t get better. However, in some cases, the condition may go away on its own after a year. It may take up to five years before the condition disappears completely.

How do I take care of myself?

There are steps you can take to manage your symptoms and side effects of medications. It’s important to maintain proper nutrition and take your medications as prescribed. In addition, make sure to get some form of physical activity every day but also allow your body to rest. Once your aches and pains start to go away, you may return to all of your normal daily activities.

When should I see my healthcare provider?

Even low-dose corticosteroids can cause side effects. If you experience any of the following, contact your healthcare provider:

• Weight gain.
• High blood pressure.
• Sleeplessness.
• Bruising or thinning of your skin.
• Cataracts.
• Osteoporosis.

Polymyalgia rheumatica may overlap with giant cell arteritis, so let your provider know if you develop any symptoms of the disease, including:

• Headaches.
• Vision changes.
• Fever.
• Fatigue.
• Loss of appetite.
• Jaw pain.
• Tenderness around your scalp.

What questions should I ask my healthcare provider?

• What caused this condition?
• What treatments do you recommend for me?
• What side effects do I need to watch out for?
• Do I have giant cell arteritis, too?
• What complications can polymyalgia rheumatica cause?
• What can I do to prevent this condition from returning?

A note from Cleveland Clinic

The symptoms of polymyalgia rheumatica can be debilitating and make it nearly impossible for you to function. If you’re experiencing severe muscle aches and stiffness, see your healthcare provider. While polymyalgia rheumatica can be difficult to diagnose, your provider can help determine what’s going on and what kind of treatment would be best for you. Some people with polymyalgia rheumatic may have giant cell arteritis, which can be a challenging condition to live with, as well. Make sure to talk to your provider about all of your symptoms.