Polymyalgia Rheumatica

Polymyalgia rheumatica is widespread aching and stiffness. Symptoms tend to come on quickly, over a few days or weeks, and sometimes even overnight. Both sides of the body are equally affected. Involvement of the upper arms, with trouble raising them above the shoulders, is common. Sometimes, aching occurs at joints such as the hands and wrists.

Achiness is always worse in the morning and improves as the day goes by. Yet inactivity, such as a long car ride or sitting too long in one position, may cause stiffness to return. Stiffness may be so severe that it causes any of these problems:

• Disturbed sleep
• Trouble getting dressed in the morning (for instance, putting on a jacket or bending over to pull on socks and shoes) or even getting out of bed
• Problems getting up from a sofa or in and out of a car

The cause of polymyalgia rheumatica (PMR) is unknown. PMR does not result from side effects of medications. The abrupt onset of symptoms suggests the possibility of an infection but, so far, none has been found. “Myalgia” comes from the Greek word for “muscle pain.” However, specific tests of the muscles, such as a blood test for muscle enzymes or a muscle biopsy (surgical removal of a small piece of muscle for inspection under a microscope), are all normal.

Recent research suggests that inflammation in PMR involves the shoulder and hip joints themselves, and the bursae (or sacs) around these joints. So, pains at the upper arms and thighs, in fact, start at the nearby shoulder and hip joints. This is what doctors call “referred pain.”

PMR should not be confused with fibromyalgia, a different syndrome that unlike PMR does not elevate typical markers of inflammation.

Polymyalgia rheumatica may be hard to diagnose. Because rheumatologists are experts in diseases of the joints, muscles and bones, they can recognize the diagnosis of PMR and expertly manage its treatment.

In PMR, results of blood tests to detect inflammation are most often abnormally high. One such test is the erythrocyte sedimentation rate (ESR), also called “sed rate.” Another test is the C-reactive protein, or CRP. Both tests may be very elevated in PMR but, in some patients, these tests may have normal or only slightly high results. Your health care providers should rule out other similar health problems, such as rheumatoid arthritis.

If your doctor strongly suspects PMR, you will receive a trial of low-dose corticosteroids. Often, the dose is 10–15 milligrams per day of prednisone (Deltasone, Orasone, etc.). If PMR is present, the medicine quickly relieves stiffness. The response to corticosteroids can be dramatic. Sometimes patients are better after only one dose. Improvement can be slower, though. But, if symptoms do not go away after two or three weeks of treatment, the diagnosis of PMR is not likely, and your doctor will consider other causes of your illness.

Nonsteroidal anti-inflammatory drugs (commonly called NSAIDs), such as ibuprofen, (Advil, Motrin, etc.) and naproxen (Naprosyn, Aleve) are not effective in treating PMR.

When your symptoms are under control, your doctor will slowly decrease the dose of corticosteroid medicine. The goal is to find the lowest dose that keeps you comfortable. Some people can stop taking corticosteroids within a year. Others, though, will need a small amount of this medicine for 2–3 years, to keep aching and stiffness under control. Symptoms can recur and often do if medicine is decreased too quickly. Because the symptoms of PMR are sensitive to even small changes in the dose of corticosteroids, your doctor should direct the gradual decrease of this medicine.

Once the stiffness has gone away, you can resume all normal activities, including exercise. Even low doses of corticosteroids can cause side effects. These include higher blood sugar, weight gain, sleeplessness, osteoporosis (bone loss), cataracts, thinning of the skin and bruising. Checking for these problems, including bone density testing, is an important part of follow-up visits with your doctor. Older patients may need medicine to prevent osteoporosis.

PMR can occur with a more serious closely related condition, giant cell arteritis. As such, you should see your doctor right away if you have PMR and you notice symptoms of headache, changes in vision, jaw pain, or fever.