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Polymyalgia rheumatica

Polymyalgia rheumatica is a disabling arthritic condition characterised by severe pain and stiffness in various muscles. 
 
Most people make a full recovery from polymyalgia rheumatica and, unlike some forms of arthritis, it does not cause any progressive disability or deformity.  Symptoms can be similar to those of other medical conditions such as rheumatoid arthritis.
 
 

Causes and risk factors

The cause of polymyalgia rheumatica (PMR) is unknown.  It is possible that the way the immune system responds to certain viruses may trigger the disease.  It is most probable that its development is triggered by a combination of genetic and environmental factors. Risk factors for developing the condition include:
 
  • Being over 60 years of age
  • Being female
  • Having European ancestry
  • Having giant cell arteritis.
PMR almost exclusively occurs after the age of 60 years, with the average age of onset being 70 years.  Women are two to three times more likely to develop the condition than men are.  PMR affects about one in 2000 people. It is more common in people of European ancestry, although it can occur in all ethnic groups.
 
PMR can be associated with another condition called giant cell arteritis (also known as temporal arteritis).   In this condition arteries in the temples and in other parts of the body become inflamed.  If the arteries to the eyes are affected, this condition can lead to blindness.  As many as 50% of people with giant cell arteritis also have PMR.
 

Signs and symptoms

The most common symptoms of PMR are severe pain and stiffness in the muscles of the shoulders, neck, lower back, buttocks and thighs.  The muscles of the upper arms may also be affected.  It is unusual for the muscles in the forearms, hands, legs and feet to be affected. The pain and stiffness is caused by mild inflammation in the joints and surrounding tissues.  Other symptoms of PMR may include:
 
  • Headache
  • Fever and/or night sweats
  • Fatigue and loss of energy
  • Loss of appetite
  • Depression
  • Weight loss
  • Mild anaemia.
In some cases the onset of PMR can be sudden and dramatic, with severe symptoms literally appearing overnight.  In other cases the condition appears gradually over a period of several weeks.  Symptoms are often worse in the morning - when they may be disabling, but tend to ease off by the afternoon.  Symptoms are often more noticeable after a period of inactivity.

The course of the condition is variable and it can last for different lengths of time for different people.  In some cases the condition may last for only a few months, yet in other cases it has been known to last for up to five years.  The average duration of PMR is two years.
 
 

Diagnosis

When the onset of the condition is sudden and dramatic, a diagnosis of PMR may be relatively easy to make.  However, when symptoms develop gradually it may be less obvious that PMR is the cause.   The symptoms of PMR can be similar to those of other medical conditions such as rheumatoid arthritis.  For this reason it is important to rule out other possible causes for the symptoms before a diagnosis of PMR can be made.

In order to make an accurate diagnosis the doctor will take a detailed medical history and perform a physical examination. There is no one definitive test that will confirm whether a person does or does not have PMR.  However, there are several blood tests that can help with the diagnosis. 
 
  • ESR (erythrocyte sedimentation rate) is often (but not always) raised in people with PMR.  This test can indicate the presence of inflammation in the body.
  • C-Reactive protein levels in the blood may be checked.  Again, elevated results can indicate the presence of inflammation in the body.
  • FBC (full blood count) often indicates the presence of mild anaemia in people with PMR.
  • To rule our rheumatoid arthritis a substance in the blood called Rheumatoid Factor may be checked. This will be elevated in people with rheumatoid arthritis; however it is normal in people with PMR.

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Treatment

Polymyalgia rheumatica is usually treated with a corticosteroid medication called prednisone.   High doses of prednisone are given initially and the dose is gradually decreased to the lowest possible level at which symptoms are controlled.  There is usually a quick response to prednisone treatment and symptoms tend to be dramatically decreased within a few days of starting the medication. 
 
Dosages will be tailored to the individual according to how well the symptoms are being controlled.  Doses may need to be increased when the body is under stress, such as after surgery, injury, or during another illness.
 
Most people can stop taking prednisone altogether within two years, though some people may need to take low doses for up to ten years. When a person is free of symptoms and has not needed to take medication for a few months the disease is considered to be in remission. 
 
While prednisone is very effective in treating PMR, long term use of the medication can produce side effects. These include:
 
  • Increased susceptibility to infections
  • Increased appetite or weight gain
  • Thinning of the bones (osteoporosis)
  • Puffiness of the face
  • Thinning and easy bruising of the skin
  • High blood pressure
  • High blood sugar levels
  • Cataracts.
The need to manage the symptoms of the PMR needs to be balanced with the potential for side effects.  It is important to never abruptly stop taking prednisone. The dosage needs to be very gradually reduced until at a level where it can be safely stopped. 

Other factors that are important in managing PMR include:
 
  • Exercising regularly – particularly low impact exercise and stretching
  • Eating a healthy, balanced diet
  • Having adequate amounts of rest.
Other medications that may be used to treat the condition include non-steroidal anti-inflammatory medications (NSAID’s). These help to reduce inflammation and lessen pain.  Some people find alternative therapies such as acupuncture, homeopathy, massage and naturopathy, are helpful in treating the symptoms of PMR.


Further support

Arthritis New Zealand is able to provide support and education to people with PMR.  The contact details are as follows:

Arthritis New
Zealand (National Office)
PO Box 10 020
Wellington
Phone: 0800 663 463
Website: www.arthritis.org.nz

There are a number of regional branches of Arthritis New
Zealand.  Refer to the local telephone directory for their contact details.
 
 

References

Anderson, K.N., Anderson, L.E. & Glanze, W.D. (eds.) (2006) Mosby’s medical, nursing, & allied health dictionary (6th ed.) St. Louis: Mosby-Year Book, Inc.

Arthritis New Zealand (2012) Polymyalgia Rheumatica.
 
Arthritis New Zealand (2007) Polymyalgia Rheumatica and Giant Cell Arteritis.

Polsdorfer, J. R. (2006) Polymyalgia rheumatica. The Gale Encyclopaedia of Medicine. Third Edition. Jacqueline L. Longe, Editor. Farmington Hills, MI. Thompson Gale.
 
Fact Sheet Revised – 30 November 2012
 

 

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