Polymyalgia Rheumatica

Polymyalgia rheumatica is diagnosed and treated by the Rheumatology Division of Premier Medical Group.

What is polymyalgia rheumatica?

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Polymyalgia rheumatica is a rare type of vasculitis that causes muscle pain and stiffness, especially in the neck and shoulders. The inflammatory condition can spread to other areas, including the hips and thighs, and symptoms typically affect both sides of the body. Symptoms of polymyalgia rheumatica typically feel worse in the morning, which can make diagnosis difficult because many people have neck and shoulder pain from sleeping in specific positions.

Polymyalgia rheumatica often affects those ages 65 and older, and it occurs more often in women than it does in men. Additionally, this condition often appears alongside giant cell arteritis, another form of vasculitis that affects the head.

What are the symptoms of polymyalgia rheumatica?

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The first and most persistent polymyalgia rheumatica symptoms include pain and stiffness in the neck and shoulders. Over time, this sensation can spread to other areas of the body. In addition to widespread muscle pain, other symptoms can include the following:

  • Weakness
  • Fatigue
  • Mild fever
  • Weight loss
  • Flu-like feeling
  • Malaise
  • Loss of appetite
  • Anemia

Symptoms often develop rapidly over the course of several days, and in some cases, they may appear overnight. Without symptom mitigation, polymyalgia rheumatica symptoms can become so intense that people have difficulty performing everyday activities. Symptoms are also known to interfere with sleep.

Polymyalgia rheumatica symptoms can feel disabling, even when they are not extremely painful. Some patients may develop depression and general malaise as a result of the condition. If you are having trouble managing this type of vasculitis, talk to your doctor and try connecting to a larger support group.

What causes polymyalgia rheumatica?

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Nobody knows the exact cause of polymyalgia rheumatica, but doctors suspect that genetic variations can increase your chances of developing the condition. We know that Caucasian women over the age of 65, but more commonly between ages 70 and 80, are the most at risk for developing the condition. Environmental factors and triggers, like viral infection, may also play a role in the disorder’s development.

Like vasculitis, polymyalgia rheumatica is thought to be an autoimmune disorder. With this type of illness, the body’s natural defense system mistakes healthy tissue to be a threat, then attacks the source. This causes either targeted or widespread inflammation, depending on the type of disorder a person has.

Does polymyalgia rheumatica affect the heart?

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Yes, polymyalgia rheumatica can increase a person’s likelihood of having a heart attack. According to studies, patients with polymyalgia rheumatica have a heart attack risk 2.5 times higher than those without the condition. Those with polymyalgia rheumatica will also have an increased risk of stroke.

Very rarely, polymyalgia rheumatica can inflame the aorta, the most important artery in the body. When this happens, it can lead to a life-threatening aortic aneurysm. Other serious complications can occur, especially in those experiencing giant cell arteritis, like blindness. Many people living with this condition will also experience mobility impairments, making it difficult to perform daily activities like bathing, standing up, and getting into a car.

How is polymyalgia rheumatica diagnosed?

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To receive a polymyalgia rheumatica diagnosis, you will need to undergo a physical exam. Your doctor will likely assess your range of motion by manually manipulating your neck, legs, and arms. They will then ask questions about your health history, then run several tests to better understand the extend of your inflammation.

Blood tests are the most common diagnostic tools for polymyalgia rheumatica. Your blood may be examined for blood cell count, erythrocyte sedimentation rate, and C-reactive protein levels. These are used to test for blood vessel inflammation.

Additionally, your doctor may use imaging tests to get a better picture of your blood vessel inflammation. Ultrasounds can be especially helpful with this condition, and MRIs can be used to detect inflammation in structures around the joints – even when the joints themselves are not directly affected.

If your doctor thinks that polymyalgia rheumatica is to blame for your symptoms, they may order a biopsy to provide a definitive diagnosis. This procedure, which is often an outpatient surgery, will allow a doctor to remove part of an artery. This will then be sent to a laboratory and examined for signs of inflammation.

What is the treatment for polymyalgia rheumatica?

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Like most autoimmune disorders, there is no known cure for polymyalgia rheumatica. Rather, treatments focus on alleviating symptoms. This condition is primarily treated with low doses of corticosteroids, which can be used to control pain and inflammation. Most patients will experience symptom relief within a few days, after which the medication dose will need to be lowered. Corticosteroids cannot be used for extended periods of time, which means maintenance doses are typically monitored and required for several months. The most commonly prescribed medication is between 10 and 15 milligrams of prednisone per day.

Patient response to corticosteroids can be dramatic, but the drugs come with their own side effects. Long-term corticosteroid use can increase a person’s chance of developing the following conditions:

  • Depression
  • High cholesterol
  • Weight gain
  • High blood pressure
  • Osteoporosis
  • Cataracts
  • Diabetes

In some cases, your doctor may recommend taking calcium and vitamin D supplements to help prevent bone loss from corticosteroid treatment. Additionally, Methotrexate, an immune-suppressing medication, can improve symptoms, but more research is needed. Some patients may also respond well to physical therapy when provided alongside medication.

It is important to remember that the best treatment for polymyalgia rheumatica is one that works for you. Symptoms of this disease affect people differently, so the treatment strategy that works for you may not have the same effect on someone else. If your treatment is causing difficult side effects, talk to your doctor about potential alternatives.