| |
Polymyalgia rheumatica is a collection of symptoms rather than a specific disease. Typical symptoms include severe and painful muscle aches and stiffness, which particularly affect 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.
Twice as many women as men develop the condition. The cause is unknown, but genetic susceptibility and ageing may play significant roles. Some researchers suspect that it is an inflammatory disorder triggered by the body’s immune system attacking the joints for reasons unknown.
Symptoms
Symptoms of polymyalgia rheumatica can include:
- Muscle pain and stiffness
- The muscles of the neck, shoulder and hip are most commonly affected
- Stiffness worsens after resting - for example, symptoms may be most severe upon rising in the morning
- Fatigue
- Night sweats
- Fever
- Depression
- Unexplained weight loss
- Painful inflammation of the blood vessels (arteries) of the skull (temporal arteritis). The temples are tender to touch and chewing may cause some pain in the side of your face. This condition may also be called giant cell arteritis.
The link to temporal arteritis (giant cell arteritis)
Up to one quarter of people with polymyalgia rheumatica experience temporal arteritis. It is important to note that if temporal arteritis is present there is a risk of damage to the arteries of the eye which can rapidly lead to blindness. This damage can be prevented if treated by corticosteroid medications.
Other possible complications of temporal arteritis include stroke and aortic aneurysm (a weak spot in the body’s main artery that bulges and threatens to burst), but these are rare. Since giant cell arteritis and polymyalgia rheumatica often occur at the same time and respond to the same treatments, some researchers suspect these conditions may be manifestations of the same underlying disease.
The cause is unknown
Polymyalgia rheumatica is considered to be a type of arthritis because it causes inflammation and swelling in the larger joints of the body, such as the shoulders and hips. The inflammation is caused by cells of the immune system attacking the membranes lining the joint (synovium), but the reason for this attack 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 twice as likely to develop the condition than men.
- Race - Caucasian (white) people are most susceptible, particularly those with Northern European or Scandinavian ancestry.
- Giant cell arteritis - about 50 per cent of people with this condition have polymyalgia rheumatica at the same time.
Diagnosis methods
Polymyalgia rheumatica has similar symptoms to other conditions, including rheumatoid arthritis and polymyositis. Diagnosis largely depends on ruling out other possible causes. Tests may include:
- Medical history.
- Blood tests to rule out other conditions - for example, people with rheumatoid arthritis often have the rheumatoid factor antibody while those with polymyalgia rheumatica don’t.
- Blood test to check for inflammation in the body by measuring the erythrocyte sedimentation rate: that is, how quickly red blood cells settle to the bottom of a test tube.
- Other blood tests - for example, people with polymyalgia rheumatica are often anaemic (have a low red blood cell count) but have more than the normal amount of platelets (blood cells that help to form clots).
- Tests to check for giant cell arteritis - for example, biopsy of the temple arteries.
Treatment options
Treatment depends on the severity of symptoms and whether or not giant cell arteritis is present. Options can include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) - such as ibuprofen and aspirin. These medications can help manage the symptoms in mild cases. Side effects of long term use can include ulceration and bleeding of the stomach and intestines.
- Oral corticosteroids - such as prednisone. This treatment is often used always when temporal arteritis is present as prompt treatment will prevent blindness. This usually provides quick relief of symptoms. Talk to your doctor if improvement has not occurred within two days. Once the person with polymyalgia rheumatica is feeling better and further blood tests show improvement, the dosage of oral corticosteroids is gradually reduced.
Complications of oral corticosteroids
About 65 per cent of patients experience at least one side effect from taking oral corticosteroids. Long term use of oral corticosteroids has a number of unwanted side effects, including:
- Weakening of the bones (osteoporosis)
- High blood pressure (hypertension)
- High blood sugars (diabetes)
- Cataracts
- Weight gain
- Reduced immune system function
- Increased susceptibility to infections
- Other drugs can be taken to minimise some of these side effects.
Don’t stop medication without doctor’s advice
You should not stop taking your corticosteroid medications or alter the dose unless advised by your doctor. It can be dangerous to stop corticosteroids suddenly.
Self-care suggestions
Self-management suggestions for polymyalgia rheumatica include:
- Gentle, regular exercise - low impact activities such as swimming or walking can help reduce muscle pain and stiffness.
- Stretching - easy stretching can improve joint mobility and ease stiffness.
- Healthy diet - good nutrition reduces the risk of drug therapy side effects such as high blood pressure and diabetes.
- Taking it easy - respect your physical limitations.
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, fatigue and depression.
- The cause is unknown, but the condition is thought to be a kind of inflammatory response.
- Up to one quarter of people with polymyalgia rheumatica experience giant cell arteritis, which is inflammation of the arteries that can cause sudden blindness in one or both eyes.
You might also be interested in:
Arthritis.
Autoimmune disorders.
Immune system.
Polymyositis.
Rheumatoid arthritis.
Sjogren's syndrome.
Want to know more?
Go to More information for support groups, related links and references.
|  |
|
