Polymyalgia Rheumatica

Polymyalgia rheumatica a common cause of widespread aching and stiffness.  It is also referred to as PMR.  It belongs to the type of disorders that lead to muscle pain and stiffness, particularly in the shoulders.  As polymyalgia rheumatica does not often lead to swollen joints, it may be hard to recognize.  Signs and symptoms of polymyalgia rheumatica come on suddenly and are worse in the morning.

Generally polymyalgia rheumatica is seen in people aged more than 65.  If rarely affect people under 50.  This condition is linked to another inflammatory disorder called giant cell arteritis.  Symptoms of giant cell arteritis are headaches, vision difficulties, jaw pain and scalp tenderness.  There are chances that a person is affected with both the conditions.

Signs and symptoms:
The signs and symptoms of this disease condition can be present on both sides of the body and might include:

• Aches or pain in your shoulders
• Aches or pain in your neck, upper arms, buttocks, hips or thighs
• Stiffness in affected areas, especially in the morning or after being inactive for a long time
• Limited range of motion in affected areas
• Pain or stiffness in your wrists, elbows or knees
• It is prevalent in whites than nonwhites, but all races can get polymyalgia rheumatica


One might also have more-general signs and symptoms including:
• Mild fever
• Fatigue
• A general feeling of not being well
• Loss of appetite
• Unintended weight loss
• Depression

When to seek a medical opinion?
It is ideal to see a doctor if you have aches, pain or stiffness that is new, interferes with your sleep, restricts your ability to do your daily activities, such as bathing and getting dressed.

The real cause of polymyalgia rheumatica is not known. Polymyalgia rhuematica does not come as a result of side effect of the medication. Two factors appear to be involved in the progression of this condition.

Genetics – Certain genes and gene variations might heighten your susceptibility

Environmental exposure – This disease condition is likely to come in cycles, maybe developing seasonally. This indicates that an environmental trigger such as a virus might have an influence on this disease. The sudden onset of the symptoms suggests the possibility of an infection. However, no specific virus has been identified to cause polymyalgia rheumatica.

Recent research indicates that inflammation in polymyalgia rheumatica involves the shoulder and the hip joints and the area around these joints.

Something to be noted here is polymyalgia rheumatica should not be mistaken for fibromyalgia.

In polymyalgia rheumatica the blood tests undertaken to detect the condition may show abnormally high results. One such test is the erythrocyte sedimentation rate. There are also other tests such as the C-reactive protein or CRP, it might also show a result which is beyond the upper end of the normal range. In some cases these tests may show normal values or marginally high values. Meanwhile, your physician also has to rule out other disease conditions, such as rheumatoid arthritis. Once diagnosed is made, it is often treated with corticosteroids. The medicine is likely to relieve the stiffness quickly.

Sometimes, patient feels better off after first dose itself, though full recovery may take time. If the symptoms do not abate even after two or three weeks of drug treatment then the diagnosis may not be polymyalgia rheumatica.

Giant cell arteritis:
As already mentioned polymyalgia rheumatica and giant cell arteritis have a lot in common. Many patients who have one of these diseases also have signs and symptoms of the other. Giant cell arteritis causes inflammation in the lining of the arteries, most probably the arteries in the temple. Signs and symptoms include headaches, jaw pain, vision problems and scalp tenderness. If left untreated, this condition can lead to serious health problems like stroke or blindness.

Risk factors for polymyalgia rheumatica:
Risk factors for polymyalgia rheumatica include:

Age: Polymyalgia rheumatica affects elderly people almost exclusively. The average age when symptoms start is 70, so people who have polymyalgia rheumatica may be in their 80s or even older.

Sex: Women are more prone to develop the disorder.

Race: Polymyalgia rheumatica is very common among white people whose ancestors were from Scandinavia or northern Europe (Caucasian).

Symptoms arising out of polymyalgia rheumatica can severely affect your ability to perform day-to-day activities, such as:
• Getting out of bed, standing up from a chair or getting out of a car
• Combing your hair or bathing
• Getting dressed

Inability to perform these activities can affect your health, social interactions, physical activity, sleep and general well-being. In addition, it has also been noted that people affected with this condition seem to be more likely to develop peripheral arterial disease, though it is usually mild and responds well to treatment.

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Q & As Polymyalgia Rheumatica


  1. What is polymyalgia rheumatica?

Polymyalgia rheumatica is an auto-inflammatory rheumatic disorder that causes muscle pain and stiffness, especially in the shoulders and hips. Signs and symptoms of polymyalgia rheumatica usually begin quickly and are worse in the morning.

It mostly affects people who are older than 65–70 years of age. Rarely it may affect younger people. Polymyalgia rheumatica is shown to be related to another inflammatory condition called temporal arteritis or giant cell arteritis, which causes inflammation of the inner lining of the arteries (in the temple region). Giant cell arteritis causes headaches, vision difficulties, jaw pain, and scalp tenderness. It is possible to have both conditions together.

  1. What causes polymyalgia rheumatica?

The exact cause of polymyalgia rheumatica is not known so far. Though, two factors appear to be involved in the development of polymyalgia rheumatic:

  • Genetics – It is believed that certain genes and gene variations increase the  susceptibility for developing this condition.
  • Environmental exposure –It is reported that most new cases of polymyalgia rheumatica tend to come in cycles, possibly developing seasonally. So it is stipulated that an environmental trigger, such as a virus, might play a role. But no specific virus has been shown to cause polymyalgia rheumatica.


  1. How is polymyalgia rheumatica diagnosed?

The diagnosis for polymyalgia rheumatica is slightly difficult because its symptoms closely resemble those of rheumatoid arthritis. Doctors do a physical exam, including joint and neurological exams, and other tests to determine the cause of the pain and stiffness. During the exam, the doctor might gently move the head and limbs to assess their range of motion.

Often the diagnosis is reassessed as the treatment progresses. Meanwhile, the doctor also monitors for signs and symptoms that can indicate the onset of giant cell arteritis since these two conditions can occur together.

Tests recommended for polymyalgia rheumatica are:

  • Blood tests.Complete blood counts, including two indicators of inflammation – erythrocyte sedimentation rate (sed rate) and C-reactive protein. These tests are often normal or only slightly high.
  • Imaging tests.Ultrasound is used to distinguish polymyalgia rheumatica from other conditions that cause similar symptoms. MRI can also identify other causes of shoulder pain, such as joint changes.


  1. How is polymyalgia rheumatica treated?

Treatment for polymyalgia rheumatica involves medications to ease the signs and symptoms:

  • A low dose of an oral corticosteroid, such as prednisone, is started for the first two to four weeks. It provides relief from pain and stiffness within the first two or three days. Most people with polymyalgia rheumatica need to continue the corticosteroid treatment for a year or more. 
  • Calcium and vitamin D.Daily doses of calcium and vitamin D supplements are advised to help prevent bone loss as a result of corticosteroid treatment.
  • Methotrexate with corticosteroids is advised in some patients. 
  • Physical therapy.


  1. Is polymyalgia rheumatica a form of arthritis?

Even though it is a type of rheumatic disorder, polymyalgia rheumatica is not a form of arthritis. Arthritis affects the joints in the body; polymyalgia rheumatica, on the other hand, affects the muscles.

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