Polymyalgia Rheumatica - Symptoms, Causes, Diagnoses and Treatments

Creator: Dr. Sneha Kannan
Published: 2019-10-03T15:01:28

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Polymyalgia Rheumatica - Symptoms, Causes, Diagnoses and Treatments

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Polymyalgia rheumatica is an inflammatory condition that results in severe pain and stiffness in the shoulders and hips. To know more, read the article below.

Written by

Dr. Sneha Kannan

Medically reviewed by

Dr. Anuj Gupta

October 3, 2019

February 21, 2023

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Contents

What Is Polymyalgia Rheumatica?
What Are the Symptoms of Polymyalgia Rheumatica?
What Causes Polymyalgia Rheumatica?
How Is Polymyalgia Rheumatica Associated With Giant Cell Arteritis?
What Are the Factors That Increase the Risk of Polymyalgia Rheumatica?
What Are the Complications of Polymyalgia Rheumatica?
How Is Polymyalgia Rheumatica Diagnosed?
What Are the Differential Diagnosis of Polymyalgia Rheumatica?
How Is Polymyalgia Rheumatica Treated?

What Is Polymyalgia Rheumatica?

Polymyalgia rheumatica (PMR) is a chronic inflammatory condition of unknown cause that affects older individuals, usually above 50 years. It is characterized by pain and morning stiffness in the hip, neck, and shoulder girdles, lasting more than half an hour.

It has been found that approximately 15 % of PMR patients develop giant cell arteritis (GCA), which is an inflammatory disease affecting large blood vessels of the scalp, arms, and neck. And more than 40 % of GCA patients have associated PMR. However, even though both of these conditions have the same onset and clinical presentation, the relationship between them is still not understood.

PMR is diagnosed based on the clinical presentation and after all other possible causes have been eliminated. This condition responds well to low doses of corticosteroids. For chronic cases, along with corticosteroids, Methotrexate or Tocilizumab are added. Prognosis is good, but it often recurs.

What Are the Symptoms of Polymyalgia Rheumatica?

The symptoms affect both sides of the body. The signs and symptoms might include:

Shoulder pain and stiffness.
Pain in the neck, arms, buttocks, hips, and thighs.
Morning stiffness.
Limited range of motion.
Pain and stiffness in wrists, elbows, or knees.
Fever.
Tiredness.
Anemia.
Limited range of motion.

Malaise.
Loss of appetite.
Unintended weight loss.
Depression.

Consult your doctor if you experience new pain or stiffness, if the pain disrupts your sleep, and if you are unable to perform usual activities because of the pain and stiffness.

What Causes Polymyalgia Rheumatica?

The cause is still not clear, but there are many theories that try to explain the cause.

Inflammation of the joints and the sacs surrounding the joints (bursae) is believed to cause pain, which radiates to other parts. For example, pain in the shoulder due to bursitis can radiate to the upper arm.
Certain gene mutations might make you more susceptible to developing PMR.
A viral infection is believed to trigger PMR, but no particular virus has been identified.

How Is Polymyalgia Rheumatica Associated With Giant Cell Arteritis?

PMR puts you at a higher risk of getting a condition called giant cell arteritis (GCA). GCA is a condition that results in inflammation of the arteries. It is an emergency condition, as there is a risk of permanent loss of eyesight or stroke. Some of the symptoms of GCA are:

Severe headaches.
Pain in the muscles of the head.
Tenderness at the temples.
Stroke.
Night sweats.
Depression.
Fatigue.
Aneurysm (enlarge) or stenosis (narrow) of blood vessels.
Jaw pain while chewing.
Scalp pain and swelling.
Blurred vision.

If you notice any of these symptoms, consult a doctor immediately. Your doctor will take a temporal artery biopsy and start you on a high dose of steroids to prevent blindness.

What Are the Factors That Increase the Risk of Polymyalgia Rheumatica?

The factors that increase the risk of polymyalgia rheumatica are:

Older adults between 70 and 80 years of age.
Women are two times more susceptible than men.
More common in white people.

What Are the Complications of Polymyalgia Rheumatica?

PMR can affect the ability to perform everyday activities, like getting out of bed, stepping out of a car, getting up from a chair, combing your hair, and dressing. These problems result in depression, sleep disturbances, and difficulties with social interactions. Some people tend to develop peripheral arterial disease.

How Is Polymyalgia Rheumatica Diagnosed?

Your doctor will perform a physical exam, which includes joint and neurological examinations. The results of these examinations can help diagnose the condition. The doctor might also check the range of motion of your joints by gently moving your head and limbs.

According to the new criteria by the American College of Rheumatology and The European League Against Rheumatism, patients older than 50 years can be diagnosed with PMR if they meet the following criteria:

Bilateral shoulder pain.
Morning stiffness that lasts more than 45 minutes.
High levels of indicators of inflammation in the blood test, for example, ESR and CRP.
Hip pain.
Absence of swelling in the small joints.
Absence of rheumatoid factors in blood tests.

In addition, some of the tests that your doctor might tell you to take are:

1. Blood Tests:

To check complete blood count (CBC) and two indicators of inflammation, which are erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).

2. Ultrasound:

Ultrasound is used to distinguish PMR from other conditions like bursitis or tenosynovitis that result in similar symptoms.

3. MRI (Magnetic Resonance Imaging):

To diagnose other conditions that can cause joint changes.

4. Testing for Giant Cell Arteritis:

Everyone with PMR is also tested for GCA. Based on your symptoms, if your doctor suspects GCA, he or she will most likely take a biopsy of the artery present in your temple.

What Are the Differential Diagnosis of Polymyalgia Rheumatica?

Conditions that can result in the same signs and symptoms of PMR are:

Rheumatoid arthritis.
Vasculitis (inflammation of blood vessels).
Infections.
Muscular disorders.
Cancer.

How Is Polymyalgia Rheumatica Treated?

The treatment options include:

Corticosteroids:

PMR is treated with a low dose of oral corticosteroid like Prednisone. It usually relieves pain and stiffness in a couple of days. The dose is gradually decreased after assessing your blood test and symptoms. The dose is kept as low as possible without relapsing. Corticosteroid has to be taken for almost a year.

Calcium and Vitamin D supplements:

To prevent bone loss caused by corticosteroids, you would have to take daily doses of calcium and vitamin D supplements. The daily dose of calcium is 1200 to 1500 mg, and that of vitamin D is 800 to 1000 IU.

Methotrexate or Tocilizumab:

Sometimes, Methotrexate or Tocilizumab is given along with the corticosteroid. Methotrexate is an immune-suppressing medication. It is usually given in relapse cases or if you do not respond to corticosteroids.

Physiotherapy:

If you are not active because of the pain and stiffness, physical therapy will be helpful.

What Are the Home Remedies for Polymyalgia Rheumatica?

Some lifestyle changes that can help are:

Eat healthily.
Consume fruits, vegetables, whole grains, lean meat, and low-fat dairy products.
Reduce salt intake.
Exercise daily. You can do exercises like water aerobics, swimming, cycling, etc.
Sleep and rest properly, as this will help your body recover faster.
Proper posture while in the office and at home.

What Are the Side Effects of Long-Term Use of Corticosteroids?

It is not advisable to start corticosteroid at a higher dose and then taper it off, as it results in relapse. Long-term use of corticosteroids can result in:

Weight gain.
Osteoporosis (loss of bone density).
Hypertension.
Diabetes.
Cataracts.
High cholesterol.
Depression.

Conclusion:

If you are suffering from polymyalgia rheumatica, you will have to take medicines for a long time, but usually, you start feeling better within a few days after starting the medicine. It is not advisable to take nonsteroidal anti-inflammatory drugs like Ibuprofen and Naproxen. Do not start any medication without consulting a doctor.

Frequently Asked Questions

1. What Foods Should Be Avoided With Polymyalgia Rheumatica?

The following are the foods that are supposed to be avoided in polymyalgia rheumatica:
- Refined carbohydrates such as white bread and white rice.
- Fried food items like oily french fries, chicken, etc.
- Sugary beverages.
- Processed meat products like salami and hot dogs, etc.
- Red meat.
- Margarine spreads.
- Foods that contain artificially added sugar.
- Alcoholic beverages.

2. What Is the Best Treatment for Polymyalgia Rheumatica?

There is no cure for polymyalgia rheumatica to date. However, the best treatment that is said to relieve maximum symptoms of this condition like pain and stiffness is achieved by the oral corticosteroid group of drugs. Prednisone is a beneficial drug in the corticosteroid group. The medication starts its action after two to three days from its date of administration.

3. What Triggers Polymyalgia Rheumatica?

The exact cause of polymyalgia rheumatica is not known yet. However, specific triggers have been suspected of causing this condition. Those include a viral infection or a combination of genetic and environmental triggers.

4. How to Diagnose Polymyalgia Rheumatica?

There is no specific diagnostic test to diagnose Polymyalgia Rheumatica. In hospitals, when a person is suspected of having polymyalgia rheumatica, a series of blood tests are usually done. It includes the erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) levels. These are the blood tests that are very useful in checking the levels of inflammation in the suspected person’s body.

5. How Long Does Polymyalgia Rheumatica Last?

Polymyalgia rheumatica usually resolves on its own over several years, even without proper medical treatment. In conditions where the affected individual is treated with medicines like corticosteroids, symptoms start to improve within a week. However, the treatment with these medicines might be needed for a period of several months to years. Sometimes, those drugs might cause additional side effects like a decreased immune function, an increase in blood uric acid levels, gastric ulcers, etc.

6. How to Treat Polymyalgia Rheumatica Naturally?

Omega-3 fatty acids have anti-inflammatory properties that can help to relieve the symptoms caused by this condition. Thus, the intake of foods containing omega-3 fatty acids can treat polymyalgia rheumatica naturally. Those includes
- Fish oils, like cod liver oil and salmon oil.
- Fishes like mackerel and sardines.
- Eggs.
- Flaxseeds.
- Chia seeds.
- Walnuts.

7. Can Polymyalgia Rheumatica Be Cured?

There is no definitive cure that has been established yet for polymyalgia rheumatica yet. However, symptomatic treatment is provided to these patients with medications such as over the counter pain relievers, corticosteroids, and disease-modifying anti-rheumatic drugs.

8. Is Polymyalgia Rheumatica and Autoimmune Disease?

The exact cause of polymyalgia rheumatica is unknown. But, with the help of the symptoms that are seen in patients affected by this condition, polymyalgia rheumatica is thought to be an autoimmune disease. However, there is a strong influence of environmental and genetic factors in the progress of this disease.

9. Is Exercise Good for Polymyalgia?

Various physical exercises, like cycling, swimming, walking, etc., can help to loosen the stiff muscles and joints in this condition. These exercises also help achieve good bone health, adequate body weight, blood circulation, and sleep. Yoga can additionally provide flexibility to joints and muscles that help in improving the joint and muscle symptoms that are seen in polymyalgia rheumatica.

10. Does Polymyalgia Ever Go Away?

It differs from person to person. In certain patients, polymyalgia rheumatica goes away on its own after several years, even without proper medical treatment. Whereas in individual patients, it lasts for their lifetime even with treatment. Researchers are still studying the reason.

11. Is Polymyalgia Rheumatica a Serious Condition?

Polymyalgia rheumatica is a painful condition, especially when it is associated with a disease known as giant cell arteritis. However, it is not a serious life-threatening condition. It usually resolves on its own very well with the help of proper medical treatment and physiotherapy.

12. What Does Polymyalgia Pain Feel Like?

The symptoms of polymyalgia rheumatica are normally felt on both sides of the body bilaterally and it includes symptoms like pain in the person’s shoulders, neck, upper arms, lumbar region, hips, and thighs. Stiffness is also noted to be present in these affected areas, particularly in the morning time since the affected individual has been inactive for a long time during his or her sleep.

13. Which Foods Can Cause a Flare-up of Polymyalgia?

Certain foods are noted to cause a flare-up of polymyalgia rheumatica. It includes processed foods because it may cause an increase in inflammation in the affected person’s body. Processed foods are also noted to cause weight gain. An increase in weight, in turn, adds more pressure to the muscles and joints that are affected by polymyalgia rheumatica, which can aggravate the person’s pain. Excessive intake of foods that contain artificial sugars is also noted to increase inflammation and may lead to weight gain.

14. Is Turmeric Good for Polymyalgia?

Yes, turmeric is good for polymyalgia. It is noted to increase the production of endogenous steroids and the regulation of their symptoms. It has also helped the affected patients in the relief of pain and a decrease in inflammation.

15. Does Polymyalgia Affect Eyesight?

Many people affected with polymyalgia rheumatica are also suffering from other related conditions such as temporal arteritis. This condition can lead to inflammation of the blood vessels, especially the vessels present at the scalp, neck, and arms of the patient. Temporal arteritis can also cause symptoms like headaches, jaw pain, and vision problems. This is how patients with polymyalgia rheumatica have a problem in their eyesight.

16. Is There an Alternative to Steroids for Polymyalgia?

As an alternative to steroids, drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying anti-rheumatic drugs (DMARDs) can be used to treat polymyalgia rheumatica. But, you would need a proper prescription from a doctor to use these drugs.

17. Is Polymyalgia a Form of Arthritis?

Polymyalgia rheumatica is an inflammatory disease that causes symptoms like widespread aching, stiffness, and flu-like symptoms. Most of these symptoms appear similar to the symptoms presented by patients affected by arthritis. Yes, polymyalgia rheumatica is a form of arthritis that primarily affects the older population.

18. Can Polymyalgia Be Treated Without Steroids?

Polymyalgia rheumatica can be treated with alternative drugs like non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying anti-rheumatic drugs (DMARDS). However, the therapeutic efficacy has not been proven to be as effective as steroids in the treatment of this condition. However, these drugs should not be self- medicated without proper medical advice.

19. Can Polymyalgia Be Brought on by Stress?

Chronic inflammatory diseases such as polymyalgia rheumatica can be a result of excessive stress experienced by the person. So, these patients might need additional psychological support in coping up with their stress.

20. What Are Other Diseases That Are Similar to Polymyalgia Rheumatica?

The following are certain other diseases who present with similar symptoms like polymyalgia rheumatica:
- Rheumatoid arthritis.
- Infections of bacterial or viral etiology.
- The inflammation of blood vessels is known as vasculitis.
- Hormonal imbalances.
- Previous history of a traumatic injury to the affected region.
- Cancer.

21. How Long Can You Take Steroids for Polymyalgia?

Once the person is started with the administration of steroids, symptoms might almost disappear after four weeks of treatment. However, treatment is continued for at least two years. In some patients, it can be required occasionally for a longer period, in order to stop the symptoms from relapsing again.

22. How Long Does Polymyalgia Take to Heal?

The time taken for recovery from polymyalgia rheumatica differs from patient to patient. Some patients recover within a month or two months with treatment. But, in some patients, especially in older adults, they take several years to heal from this condition.

23. What Is the Prognosis for Polymyalgia Rheumatica?

Polymyalgia rheumatica is a self-limiting disease. In untreated patients, there can be an impaired quality of life. But, if the diagnosis is early and treatment is adequate, patients usually have an excellent prognosis. The normal course of this disease is three years.

24. Does Polymyalgia Make You Feel Ill?

The additional symptoms experienced by patients, along with pain and stiffness, usually make them feel ill. Those include:
- Weakness.
- Low-grade fever.
- Loss of appetite.
- Weight loss.
- Fatigue.
- Malaise.
- Depression.

25. Does Polymyalgia Affect the Knee?

Yes, polymyalgia rheumatica affects knees along with other parts of the body like,
- Neck.
- Upper arms.
- Buttocks.
- Hips
- Thighs.
- Elbows.
- Wrists.

26. Does Polymyalgia Rheumatica Affect the Heart?

Yes, polymyalgia rheumatica affects the heart by increasing the risk of certain conditions. It might include myocardial infarction and other coagulopathies. These conditions can apparently affect the heart.

Sources

Dr. Anuj Gupta

Spine Surgery

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