Polymyalgia rheumatica

Polymyalgia rheumatica is a condition causing pain and stiffness in older adults. Typical symptoms include severe and painful muscle aches and stiffness, particularly affecting the neck, shoulders and thighs. The onset is usually sudden. People aged 50 years and over are most commonly affected. The average age of diagnosis is 70 years. It is common and very treatable.

The cause is unknown but genetics and environmental factors, such as an infection, are believed to play a role. Polymyalgia rheumatica should not be confused with fibromyalgia – a condition that causes pain and muscle stiffness, but does not cause inflammation.

Symptoms of polymyalgia rheumatica

Symptoms of polymyalgia rheumatica can include:

• Muscle pain and stiffness, particularly in the neck, shoulders, hips and upper arms
• Stiffness worsens after resting – for example, symptoms may be most severe upon rising in the morning
• Fatigue
• Difficulty sleeping
• Difficulty raising arms above shoulder height
• Unexplained weight loss.

Polymyalgia rheumatica and giant cell arteritis (temporal arteritis)

Approximately one in five people with polymyalgia rheumatica experience giant cell arteritis (also known as temporal arteritis). This involves painful inflammation of the blood vessels (arteries) of the skull. The temples are tender to touch and chewing may cause some pain in the side of your face. Giant cell arteritis can cause damage to the arteries of the eye, which can lead to blindness. This damage can be prevented if treated promptly.

See your doctor immediately if you experience headaches, blurred or double vision, if your temples are tender to touch and if chewing causes pain in the side of your face.

The cause is unknown

Polymyalgia rheumatica causes inflammation and swelling in the larger joints of the body, such as the shoulders and hips, and in the tissues around these joints. The inflammation is caused by cells of the immune system attacking the membranes lining the joint (synovium), but the reason for this is unknown.

Risk factors for polymyalgia rheumatica include:

• Advancing age – the condition is more common in people aged 50 years and over, with most sufferers diagnosed at around 70 years.
• Gender – women are more likely to develop the condition than men.
• Race – Caucasian (white) people are most susceptible.

Diagnosis of polymyalgia rheumatica

There is no single test that can diagnose polymyalgia rheumatica, so your doctor will make a diagnosis based on a number of factors. These include your medical history, a physical examination, tests that measure the levels of inflammation markers in the blood and tests to rule out other possible causes.

Tests may include:

• Blood tests to check for inflammation in the body by measuring the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) blood level
• Blood tests to rule out other conditions
• Tests to check for giant cell arteritis – for example, biopsy of the temple arteries.

Treatment for polymyalgia rheumatica

Most people with polymyalgia rheumatica will be treated with corticosteroid medication. The amount prescribed will depend on the situation: a higher dose will be prescribed in more severe conditions and when giant cell arteritis is present. The aim of treatment is to relieve the symptoms and slowly reduce the dose to the lowest possible amount without the return of symptoms.

Complications of oral corticosteroids

Long-term use of oral corticosteroids can cause a number of unwanted side effects, so it is important to see your doctor regularly while taking these medications. If you have any concerns about the side effects of corticosteroids, you should discuss them with your doctor.

Self-management

There are many things that you can do to help yourself if you have polymyalgia rheumatica. Suggestions include:

• Learn more about polymyalgia rheumatica – so that you can make informed decisions about your healthcare and play an active role in the management of your condition.
• Get active – low-impact activities such as swimming or walking can help reduce muscle pain and stiffness.
• Enjoy a healthy well-balanced diet – this can help you reach and maintain a healthy weight and reduce your risk of other health problems.
• Pace yourself – plan and organise your activities so you make the most of your energy.
• Learn new ways to manage pain – there are many ways you can manage the pain of polymyalgia rheumatica. Try different techniques until you find what works best for you.

Where to get help

• Your doctor
• Rheumatologist
• The Royal Victorian Eye and Ear Hospital Tel. (03) 9929 8666
• Arthritis Victoria Tel. (03) 8531 8000 or 1800 011 041

Things to remember

• Symptoms of polymyalgia rheumatica include severe muscle aches and stiffness, unexplained weight loss and fatigue.
• The cause is unknown, but genetics and environmental factors are believed to play a role.
• Approximately one in five people with polymyalgia rheumatica experience giant cell arteritis, which is inflammation of the arteries. If left untreated, giant cell arteritis can cause blindness in one or both eyes.

You might also be interested in:

• Arthritis.
  
• Autoimmune disorders.
  
• Eye conditions - giant cell arteritis.
  
• Immune system.
  
• Polymyositis.
  
• Rheumatoid arthritis.
  
• Sjogren's syndrome.
  

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Arthritis Victoria

Last reviewed: August 2011

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Polymyalgia rheumatica is a condition causing pain and stiffness in older adults. Typical symptoms include muscle aches and stiffness, fatigue and difficulty raising arms above shoulder height. Middle-aged and older women are most commonly affected. Approximately one in five people with polymyalgia rheumatica experience giant cell arteritis.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

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