Polymyalgia Rheumatica and Temporal Arteritis
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.
Can Other Problems Mimic Polymyalgia Rheumatica?
Yes. Some other illnesses that may be confused with polymyalgia rheumatica include:
How Are Polymyalgia Rheumatica and Temporal Arteritis Treated?
There is no known cure for polymyalgia rheumatica and temporal arteritis, but these diseases can be treated and controlled. Corticosteroids -- often called "steroids" -- help rapidly relieve the symptoms of both conditions.
Treatment with steroids -- usually in the form of prednisone -- is mandatory for temporal arteritis to prevent serious complications, such as blindness. Low doses of steroids are often successful in treating polymyalgia rheumatica. Higher doses are often required to treat temporal arteritis.
The excellent response to treatment is so uniform that the lack of dramatic improvement, within days, would make the diagnosis of temporal arteritis or polymyalgia rheumatica doubtful.
Steroids reduce the function of inflammatory cells that cause these illnesses. Consequently, steroids minimize tissue damage. Steroids also impair the immune system -- thus increasing the risk of infection.