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Polymyalgia rheumatica is a subtype of arthritis that is characterized by significant muscle and joint stiffness. This article outlines the causes, risk factors, symptoms, diagnosis and treatment of polymyalgia rheumatica.

Arthritis is an umbrella term that includes more than 100 individual diseases, one of which is a disease known as polymyalgia rheumatica. Patients with polymyalgia rheumatica, a type of inflammatory arthritis, develop widespread aches, stiffness of joints and muscles and flu-like symptoms. Fortunately, polymyalgia rheumatica is not life-long condition and only lasts between one to five years, though the duration can vary from individual to individual.

Causes of polymyalgia rheumatica

While researchers are unsure why polymyalgia rheumatica develops, most believe that it is an autoimmune disease. Generally, the immune system is responsible for keeping us healthy by attacking foreign pathogens such as bacteria and viruses. In the case of some diseases, the immune system goes haywire and starts to attack the body’s own tissue instead. These diseases, which include polymyalgia rheumatica, are known as autoimmune diseases.

Another theory is that polymyalgia rheumatica develops due to the aging process. Evidence for this theory comes from the fact that it is seldom diagnosed in people younger than 50 years of age.

Polymyalgia rheumatica: Risk factors

These are the known risk factors that predispose an individual to polymyalgia rheumatica:

  • Age. The disease is typically seen in older patients. The average age of onset of polymyalgia rheumatic is 70 years.
  • Gender. Polymyalgia rheumatica is generally diagnosed in women rather than men.
  • Ethnicity. Caucasian people are more likely to get polymyalgia rheumatica compared to other ethnicities.

Symptoms: What warning signs will polymyalgia rheumatica patients experience?

Symptoms associated with the development of polymyalgia rheumatica can either appear suddenly or develop gradually over a period of time. Generally, symptoms of polymyalgia rheumatica develop because of the inflammation present in the joints and surrounding tissues. Some of the symptoms associated with progression of polymyalgia rheumatica include:

  • Muscle and joint stiffness, which is particularly bad in the morning and during times of inactivity.
  • Pain and stiffness that affect various parts of the body such as the butt, neck, thighs, hips, upper arms and shoulders.
  • Weakness, which results due to long-term non-use of various body parts due to the stiffness and pain associated with their use.
  • Fatigue
  • Fever
  • Loss of appetite
  • Weight loss
  • Headaches, especially on the side of the head
  • Changes that affect eye sight or vision
  • Sensitivity in the scalp
  • Mouth or jaw pain

A small percentage of people with polymyalgia rheumatica can also develop a serious disease called giant cell arteritis, in which the cells within the lining of the arteries under the skin become inflamed. It most often strikes the arteries in the head, giving patients a unique appearance.

Diagnosis: How do doctors diagnose polymyalgia rheumatica?

If your family doctor suspects that you may have arthritis, they will likely refer you to a rheumatologist. However, polymyalgia rheumatica can be hard to diagnose. In order to make a diagnosis, the doctor will:

  1. Ask details about the symptoms. The doctor will ask you to describe the symptoms exactly, when they started, how severe they are, whether they flare up or are constant and ask other questions that can helpful in elucidating what kind of disease you have.
  2. Conduct a medical and personal health history. The doctor will ask you about your daily habits, diet, whether anybody in your family has arthritis and other important details.
  3. Conduct a physical examination. The doctor will physically examine the joints and muscles that are involved in the disease to determine whether the disease involvement is characteristic of polymyalgia rheumatica.
  4. Order blood tests to look for levels of proteins and other factors that can help determine levels of inflammation or to rule out other, related conditions. For example, the doctor will order C-reactive protein test and/or erythrocyte sedimentation rate test as these two tests are indicative of levels of inflammation. The doctor will also order a rheumatoid factor test that can help exclude a diagnosis of rheumatoid arthritis.

Treatment: How is polymyalgia rheumatica managed?

Currently, similar to other rheumatic diseases, there is no cure for polymyalgia rheumatica. Hence, treatment for the disease focuses on decreasing pain and improving inflammation. Additionally, treatments help reduce stiffness and fatigue of muscles. The treatments for polymyalgia rheumatica include:

  • Corticosteroids. These are strong anti-inflammatory medicines that help decrease inflammation and ease stiffness and pain. These corticosteroids can be administered intravenously (into the vein), orally (through a tablet) or straight into the joint or muscle that is involved in the disease. Corticosteroids are the gold standard for treatment of polymyalgia rheumatica. The dosage of corticosteroids that are used for treatment of polymyalgia rheumatica is generally low and symptoms tend to improve rapidly with treatment. Additionally, the dosage is often decreased once symptoms ease.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (advil) and naproxen (aleve), help reduce inflammation and pain, and ease symptoms. These are often prescribed in the cases of mild polymyalgia rheumatica. Stronger NSAIDs are available through a prescription if your disease doesn’t respond to over-the-counter NSAIDs.
  • Exercise. Exercise plays an important role in helping maintain flexibility of joints, muscle strength and bodily function. Some of the low-impact exercises that physicians recommend is swimming, walking, aerobics or riding a bike.
  • Rest. It is important to rest and have your body recover from a day of exercise and activities. Rest plays an important role in the treatment of polymyalgia rheumatica.

  • Bird, H. A., et al. "An evaluation of criteria for polymyalgia rheumatica." Annals of the Rheumatic Diseases 38.5 (1979): 434-439.
  • Salvarani, Carlo, Fabrizio Cantini, and Gene G. Hunder. "Polymyalgia rheumatica and giant-cell arteritis." The Lancet 372.9634 (2008): 234-245.
  • Jones, J. G., and B. L. Hazleman. "Prognosis and management of polymyalgia rheumatica." Annals of the Rheumatic Diseases 40.1 (1981): 1-5.
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