Polymyalgia Rheumatica and Temporal Arteritis

Medically Reviewed by Zilpah Sheikh, MD on April 13, 2024
Written by Stacey Jones, MS, BA, WebMD Editorial Contributor
7 min read

Polymyalgia rheumatica (PMR) is an inflammatory condition that causes widespread pain, stiffness, or aching in the large muscle groups, especially around the shoulders, hips, lower back, neck, and thighs. Polymyalgia means "many muscle pains," and rheumatica means "changing" or "in flux." 

PMR doesn't cause swelling, which makes it tricky to diagnose. Its symptoms are usually more severe in the morning and may appear suddenly. It's thought that the pain caused by PMR may be related to inflammation of the bursae, which are thin, fluid-filled sacs that reduce joint friction, located in the hips and shoulders. And inflammation caused by PMR responds well to treatment.

Symptoms of PMR tend to develop quickly. In addition to muscle pain, other symptoms may include:

  • Stiffness around the shoulders and hips, especially in the morning and after resting
  • Weakness
  • Fatigue
  • Generally feeling ill
  • Mild fevers (occasionally)
  • Weight loss

Does polymyalgia rheumatica affect the legs?

PMR may cause pain and stiffness in your thigh but doesn't usually affect your lower legs (as well as lower arms, hands, and feet). Pain and stiffness typically begin on one side of the body and eventually affect both sides.

About 10%-20% of people with polymyalgia rheumatica also have temporal arteritis. On the other hand, 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 comes 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."

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 (caused by decreased blood flow to the eye )
  • Stroke (rare)
  • Fatigue
  • Fever
  • Weight loss
  • Night sweats
  • Depression
  • Feeling ill

Polymyalgia rheumatica generally affects people over age 50. The average age of patients with PMR is 70. The disease is more common among women, and Caucasians are more likely to get PMR than other ethnic groups.

The exact cause of PMR is unknown, but it's thought to be an autoimmune disorder in which the body attacks itself. It could also be due to aging; your genetics or environment might play a role too.

Under the new criteria developed by the American College of Rheumatology and the European League Against Rheumatism, patients aged 50 or older can be classified as having PMR if they meet the conditions below:

The new classification criteria may also help evaluate existing treatments for PMR.

Everyone with PMR is typically tested for temporal arteritis. This starts with an 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 involves taking a sample from 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 despite the person having temporal arteritis.

Some other illnesses that may be confused with polymyalgia rheumatica include:

  • Rheumatoid arthritis
  • Infections
  • Inflammation of blood vessels (vasculitis)
  • Chemical and hormonal abnormalities
  • A variety of muscle diseases
  • Cancer

Polymyalgia rheumatica vs. fibromyalgia

Both PMR and fibromyalgia cause muscle pain. Both conditions mostly affect women. While PMR is thought to be an inflammatory disease, fibromyalgia is not. Researchers believe that fibromyalgia is caused by an atypical central nervous system response that makes you very sensitive to pain. Fibromyalgia affects all areas of your body -- top, bottom, left, and right -- and you will usually have tender points in various places.

Polymyalgia rheumatica vs. rheumatoid arthritis

PMR and rheumatoid arthritis both impact older adults. In PMR, muscle pain is marked by morning stiffness, typically affecting your shoulders and hips, while rheumatoid arthritis pain is usually accompanied by swelling of the joints of the hands, feet, and knees. However, it can be difficult for doctors to distinguish between the two conditions.

Polymyalgia rheumatica treatment includes low doses of corticosteroids that work quickly to relieve your pain and stiffness.

Polymyalgia rheumatica medication

Steroids reduce the function of inflammatory cells that cause the illness. 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, the presence of other illnesses, and the 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 watch out for possible side effects and to check the effectiveness of therapy. These blood tests can usually detect problems before you feel any symptoms. Your doctor will frequently examine your heart and lung function and blood sugar level, which may increase after you start taking steroids.

You may have to continue steroid treatment for a year or so. While being treated for PMR, it is important to keep all your doctor and lab appointments and have your blood pressure checked regularly. Your doctor will also watch for signs of temporal arteritis.

The medications for PMR increase your chance of developing infections. So, if you see symptoms such as a cough, fever, or shortness of breath, inform your doctor.

Calcium and vitamin D therapy

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.

Methotrexate

The American College of Rheumatology recommends combining methotrexate and corticosteroid therapy for certain patients. Methotrexate, a rheumatoid arthritis medication, suppresses the immune system, but it may be an effective early treatment, particularly if you don't respond well to corticosteroids.

If left untreated, PMR can cause mobility issues and make it difficult for you to bathe or dress yourself or perform other daily activities, such as grooming, rising to a standing position, or getting in and out of cars. Rarely, the inflammation from polymyalgia can lead to an aortic aneurysm, a potentially life-threatening condition.

However, you are at the greatest risk of developing temporal arteritis, so it's important to recognize those symptoms and see your doctor promptly. Temporal arteritis, which can affect your aorta, can also leave you in danger of an aortic aneurysm, blindness, or a stroke.

With careful monitoring and proper treatment, most patients with polymyalgia rheumatica have a normal life span and lifestyle.

The success of treatment is related to prompt diagnosis, aggressive treatment, and careful follow-up to prevent or minimize side effects from the medications.

Will polymyalgia rheumatica go away?

After starting treatment, your symptoms should ease in a couple of days. However, it usually takes a year or more, particularly if you relapse, until you no longer need treatment and your symptoms disappear completely. Some people prone to recurrent PMR may need to take low doses of steroids for life. The condition doesn't resolve on its own without treatment.

It can be tough to live with polymyalgia rheumatica as you juggle work, relationships, and responsibilities. The pain, tiredness, stress, and medication side effects can take a toll on you. However, PMR is highly treatable, and most of those who have it recover within 5 years, sometimes in as little as 1 year.

Once your symptoms get better, you'll be able to resume normal activities. In the meantime:

  • Take your medicines as directed.
  • Eat a healthy diet.
  • Exercise, but get plenty of rest too.
  • When in pain, use devices that can help you with daily activities.

Because steroids are the most effective treatment for polymyalgia rheumatica, you should avoid alcohol when taking them. Drinking and smoking can increase the risk of osteoporosis, a potential side effect of steroid therapy. Supplementing your treatment with vitamin D and calcium, as well as weight-bearing exercises, should help protect your bones.

Polymyalgia rheumatica is marked by morning stiffness and pain, particularly in the shoulders and hips. About 10%-20% of people who have PMR are at risk of developing temporal arteritis, a serious condition that causes inflammation in your aorta, the major artery that carries blood from your heart. Polymyalgia rheumatica responds well to treatment (usually steroids) that focuses on improving symptoms of inflammation, pain, and stiffness. Physical activity helps reduce symptoms as well, particularly walking, stationary cycles, and water exercise, but don't overdo it.

What are the warning signs of temporal arteritis?

Tell your doctor if you have any of the following symptoms, which may indicate you are developing temporal arteritis:

  • New, frequent, or unusual headaches
  • Pain or stiffness in your jaws
  • Blurry or double vision or a complete loss of vision
  • A tender scalp

Does polymyalgia rheumatica affect the brain?

About 10%-20% of people with PMR may develop temporal (giant cell) arteritis, which if left untreated can affect your vision and brain, leading to possible blindness or a stroke.

Does polymyalgia rheumatica affect the legs?

PMR may cause pain and stiffness in your thighs, but it usually doesn't affect your lower limbs.