Understanding Polymyalgia Rheumatica: Symptoms, Diagnosis, and Treatment

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. The term "polymyalgia" means "many muscle pains," while "rheumatica" refers to the changing or fluctuating nature of the condition.

PMR is more common in people over 50, with an average age of 70 at diagnosis. Women are more likely to develop PMR than men, and Caucasians have a higher risk compared to other ethnic groups. Although the exact cause is unknown, PMR is thought to be an autoimmune disorder, where the body's immune system attacks its own tissues.

Symptoms of Polymyalgia Rheumatica

The primary symptoms of PMR include:

• Stiffness and pain in the shoulders and hips, especially in the morning or after resting

• Weakness and fatigue

• Generally feeling unwell

• Mild fevers (occasionally)

• Weight loss

These symptoms usually develop quickly and may be more severe on one side of the body before affecting both sides.

The Link Between Polymyalgia Rheumatica and Temporal Arteritis

About 10-20% of people with PMR also develop temporal arteritis, an inflammatory condition that damages large and medium-sized arteries, particularly those supplying blood to the head and temples. Symptoms of temporal arteritis include severe headaches, scalp tenderness, jaw pain, vision changes, and in rare cases, stroke.

Diagnosing Polymyalgia Rheumatica

Diagnosing PMR involves a combination of physical examination, patient history, and blood tests to measure inflammation levels. The American College of Rheumatology and the European League Against Rheumatism have developed classification criteria for PMR, which include:

• Age 50 or older, more commonly in females and people of northern European descent

• Bilateral shoulder pain

• Morning stiffness lasting at least 45 minutes

• Elevated inflammation markers in blood tests

• New hip pain

• Absence of swelling in the small joints of the hands and feet

• Negative blood tests for rheumatoid arthritis

• Blood tests for elevations in ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein)

In some cases, a temporal artery biopsy may be necessary to confirm a diagnosis of temporal arteritis.

Treatment Options for Polymyalgia Rheumatica

The primary treatment for PMR is low-dose corticosteroids, which work quickly to relieve pain and stiffness. Steroids reduce inflammation by impairing the function of inflammatory cells, thus minimizing tissue damage. However, long-term steroid use can lead to side effects such as osteoporosis, so patients are often prescribed calcium and vitamin D supplements to protect their bones.

In some cases, doctors may recommend combining steroids with methotrexate, a medication that suppresses the immune system. This combination may be particularly effective for patients who do not respond well to corticosteroids alone.

Regular monitoring through blood tests and check-ups is essential to detect potential side effects and adjust treatment as needed. Patients should also be vigilant for signs of infection, as steroid use can increase the risk of developing infections.

Living with Polymyalgia Rheumatica

Living with PMR can be challenging, as pain, fatigue, and medication side effects can impact daily life. However, with proper treatment, most people with PMR recover within 1-5 years. To manage the condition effectively:

• Take medications as prescribed

• Maintain a healthy diet

• Engage in gentle exercise, such as walking or water-based activities

• Use assistive devices when needed

• Get adequate rest

It is also important to avoid alcohol and smoking while undergoing steroid treatment, as these can increase the risk of osteoporosis.

In Conclusion

Polymyalgia rheumatica is a treatable inflammatory condition that primarily affects older adults. By understanding the symptoms, diagnosis, and treatment options for PMR, patients can work with their healthcare providers to manage the condition effectively and maintain a good quality of life. Regular monitoring and a healthy lifestyle are key to minimizing the impact of PMR and its associated risks, such as temporal arteritis.

For more information on polymyalgia rheumatica and its management, consult the following resources:

• American College of Rheumatology - Polymyalgia Rheumatica

• NHS - Polymyalgia Rheumatica

• National Institute of Arthritis and Musculoskeletal and Skin Diseases - Polymyalgia Rheumatica

The Bottom Line

Most patients experience remarkable improvement within days of starting low-dose corticosteroids, but successful treatment requires careful monitoring and gradual tapering to prevent relapse while minimizing steroid side effects. If you're over 50 with severe morning stiffness and shoulder pain that improves throughout the day, Doctronic can help evaluate your symptoms quickly.