Polymyalgia Rheumatica and Temporal Arteritis
Polymyalgia rheumatica is an infrequently occurring, inflammatory condition that causes pain or aching in the large muscle groups, especially around the shoulders and hips. Polymyalgia literally means "many muscle pains." Rheumatica means "changing" or "in flux."
What Are the Symptoms of Polymyalgia Rheumatica?
Symptoms of polymyalgia rheumatica tend to develop quickly and in addition to muscle pain, other symptoms may include:
- Stiffness around the shoulders and hips, especially in the morning and after resting
- Generally feeling ill
- Mild fevers (occasionally)
- Weight loss
What Is Temporal Arteritis?
About 15% of people with polymyalgia rheumatica also have temporal arteritis and about half of people with temporal arteritis also have polymyalgia rheumatica. Temporal arteritis causes inflammation that damages large and medium-sized arteries. The name of the condition stems from the fact that some of the affected arteries provide blood to the head, including the temples. Temporal arteritis is also known as "giant cell arteritis."
What Are the Symptoms of Temporal Arteritis?
Temporal arteritis has several symptoms, including:
- Severe headaches, the most common symptom.
- Scalp tenderness.
- Jaw or facial soreness, especially with chewing.
- Vision changes or distorted vision that's caused by decreased blood flow.
- Stroke may occur in less than 5% of patients as a result of decreased blood flow.
- The large blood vessels may become narrowed (stenosis) or enlarged (aneurysm). If narrowing occurs in the blood vessels leading to the arms or legs, patients may notice fatigue or aching in the limbs, due to a reduced blood supply. Your doctor may notice weak or absent pulses and possibly noises in the upper chest.
- Other symptoms may include fever, weight loss, night sweats, depression, fatigue, and a general feeling of being ill.
Who Gets Polymyalgia Rheumatica and Temporal Arteritis?
Polymyalgia rheumatica and temporal arteritis frequently affect the same types of people. People over 50 years old are most often affected. The average age of patients is 70. These diseases are more common among women, and Caucasians are more likely to get these diseases than other ethnic groups.
The exact cause of these illnesses is unknown.
How Are Polymyalgia Rheumatica and Temporal Arteritis Diagnosed?
Under the new criteria developed by the American College of Rheumatology and The European League Against Rheumatism, patients 50 years and older can be classified as having PMR if they meet all of the conditions below:
- Shoulder pain on both sides
- Morning stiffness that lasts at least 45 minutes
- High levels of inflammation measured by blood tests
- Reported new hip pain
- Absence of swelling in the small joints of the hands and feet, and absence of positive blood tests for rheumatoid arthritis
The new classification criteria may also help to evaluate existing treatments for polymyalgia rheumatica.
Everyone with polymyalgia rheumatica is also tested for temporal arteritis. This, too, would start with the exam and listening to the patient's symptoms.
If temporal arteritis is suspected, but less convincing features are present, a temporal artery biopsy may confirm the diagnosis. The biopsy is taken from a part of the artery located in the hairline, in front of the ear. In most cases the biopsy is helpful, but in some individuals it may be negative or normal, even though the person does have temporal arteritis.