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:
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 to the eye.
- 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.
- 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 age 50 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 ages 50 years and older can be classified as having PMR if they meet 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.
Temporal arteritis may also be treated with methotrexate or a biologic drug called tocilizumab (Actemra). Tocilizumab is given as an injection under the skin to decrease the amount of steroid a person needs. . This medicine may be used along with steroids
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.
The decision to prescribe steroids is always made on an individual basis. Your doctor will consider your age, presence of other illnesses and medications you are taking. Your doctor also will make sure you understand the potential benefits and risks of steroids before you start taking them.
You will have frequent blood tests while taking steroids or other medications to monitor for possible side effects and to evaluate the effectiveness of therapy. These blood tests can usually detect problems before you are aware of any symptoms. Your doctor will frequently evaluate your heart and lung function and blood sugar level, which may increase after you start taking steroids.
While being treated for polymyalgia rheumatica or temporal arteritis, it is important to keep all appointments with your doctor and the lab, and have your blood pressure checked regularly.
Because the medicines used to treat polymyalgia and temporal arteritis increase your chance for developing infections, report symptoms such as a cough, fever, or shortness of breath to your doctor.
Long-term steroid treatment (for a few months to several years) requires additional testing and monitoring. The long-term use of steroids can cause osteoporosis (bone loss), which can be detected with scans similar to X-rays. Taking supplements of calcium and vitamin D, sometimes along with prescription medication is recommended to prevent osteoporosis in people taking steroids. Discuss the potential side effects caused by your treatment with your doctor.
What Is the Long-Term Outlook for Polymyalgia Rheumatica and Temporal Arteritis?
With careful monitoring and appropriate treatment, most patients with polymyalgia rheumatica or temporal arteritis have a normal life span and lifestyle. Most of the time, these diseases can be successfully controlled with steroids and other drugs (including tocilizumab, a rheumatoid arthritis drug which has been touted for people who have trouble with or are nonresponsive to steroids),
The success of treatment is related to prompt diagnosis, aggressive treatment, and careful follow-up to prevent or minimize side effects from the medications.