Polymyalgia rheumatica

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 27, 2016
StartDiseasesPolymyalgia rheumatica

Polymyalgia rheumatica affects the joints and can cause pain and limited mobility. Although the disease affects day-to-day life and causes significant pain and discomfort, polymyalgia rheumatica is highly treatable.

Contents

Definition & Facts

Polymyalgia rheumatica is classified as an inflammatory disorder or a form of arthritis. It is associated with giant-cell arteritis and occurs when the lining around the joints become inflamed, and it results in muscle pain, especially around the shoulders. It mostly affects people over the age of 65, and it rarely occurs in people under the age of 50. The average age of onset is about 70 years.

Women are about twice as likely to develop polymyalgia rheumatica as men, and Caucasian people are more likely to develop it than people of other demographics. The symptoms usually appear quickly and suddenly, and they can worsen over time. Although the disease is sometimes painful, patients can live healthy and productive lives if they seek treatment.

Symptoms & Complaints

The disease mainly affects the shoulders, so pain in the shoulders is almost always the first symptom. It is often accompanied by neck, hip pain, thigh pain, buttocks pain, and upper arm pain. Many people also experience a limited range of motion in their shoulders or legs.

Some people with the disease display flu-like symptoms, especially fatigue, fever, and unexplained weight loss. Other less common symptoms include depression and loss of appetite.

Because the disease causes joint pain and limited mobility, some people with a severe case of polymyalgia rheumatica may struggle to get out of bed, step out of a car, bathe, get dressed, or carry out other day-to-day activities. Most people feel the symptoms most severely in the morning, and the pain lessens throughout the day. However, the symptoms can worsen after spending a long time sitting in one position, such as during a long car ride or at an office desk.

Causes

Researchers and doctors are unaware of the cause of polymyalgia rheumatica. They believe, though, that it is caused either by genetic factors, environmental factors, or a combination of both. Some researchers believe that people with particular genes or genetic mutations have an increased likelihood of developing the disease.

Other research suggests that something in the environment, like a viral infection, may cause the disease. Polymyalgia rheumatica often occurs in patients seasonally, which points to the possibility that a virus may be responsible. The sudden onset of the symptoms also supports the idea that the disease is caused by an infection. However, researchers haven't yet found a specific environmental trigger that could cause the disease.

It may occur as a combination of genetics and an environmental factor. Some people may have a genetic predisposition to the disease but only develop it after being exposed to an environmental trigger. In rare circumstances, polymyalgia rheumatica can be caused by a cancer. Some cancers can cause an inflammatory response in the joints, which results in the polymyalgia rheumatica symptoms.

Diagnosis & Tests

To diagnose polymyalgia rheumatica, a doctor will usually ask questions about the patient's symptoms. They may ask about the location of the pain or stiffness, the severity of the symptoms, the time of day the symptoms are most severe, and whether the symptoms limit daily activities. A diagnosis also usually involves a general physical examination in order for the doctor to observe the patient's overall health and rule out other possible diseases causing the symptoms.

The doctor may assess the patient's range of motion by slowly moving their head, neck, or limbs. After the general exam, the doctor may take a blood test to check the complete blood count and to look for erythrocyte sedimentation rate and C-reactive protein, which can both indicate inflammation resulting from the disease.

The blood test is the best way to diagnose the disease, but in some cases, the doctor may also send the patient for an ultrasound. An ultrasound can help rule out other potential conditions with similar symptoms. Some doctors send patients for magnetic resonance imaging (MRIs) to check for other causes of pain or stiffness in the shoulder, like degenerative joint diseases like osteoarthritis. If an ultrasound or MRI show no other conditions and the blood tests show high levels of erythrocyte sedimentation rate and C-reactive protein, the doctor may diagnose polymyalgia rheumatica.

Treatment & Therapy

The most common treatment for polymyalgia rheumatica is an oral corticosteroid medication such as prednisone. Most people with the disease take between 12 and 25 mg per day at the start of their treatment, but the exact dosage varies depending on the age and size of the patient and the severity of the symptoms.

The corticosteroid should start relieving the symptoms within a few days. If it doesn't, the doctor may send the patient to a rheumatologist for more testing or other treatments. However, the corticosteroid is effective in treating the majority of patients.

After a few weeks of treatment, the doctor usually gradually lowers the dosage as the symptoms diminish. Most people take the medication for a year or more because quickly reducing or eliminating the medication use can cause a relapse in symptoms.

If the patient has a severely limited range of motion or intense pain due to the disease, the doctor may recommend physical therapy to help with mobility. Many patients also choose to use mobility aids like assistive canes and reaching aids, to put less strain on their joints. 

Patients can also make some lifestyle changes to help manage their polymyalgia rheumatica symptoms. Eating plenty of fruits, vegetables, and whole grains while limiting salt consumption can help with pain and stiffness. Exercising regularly can help strengthen the bones and muscles, which can improve mobility and reduce pain.

Prevention & Prophylaxis

There is no known way to prevent polymyalgia rheumatica. Because the symptoms occur so suddenly and researchers don't know the cause of the disease, it's difficult for an individual to know whether they're at risk for developing it.

People with the disease can prevent their symptoms from worsening, though, by receiving treatment quickly after they notice symptoms. If they receive treatment shortly after noticing the first symptoms of the disease, they may be able to get rid of their symptoms within just a few days.

Relapse is common, however so following the treatment and medication regimen and having regular, follow-up doctor's visits are necessary.