Polymyalgia rheumatica
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Polymyalgia rheumatica is an inflammatory condition that causes pain and stiffness in the neck, shoulders, and hips, mainly in people over 50. Symptoms typically start off fast and get worse in the morning or after inactivity. Morning stiffness typically persists for at least 30 minutes or longer. While the pain can be severe, it may ease with movement.
Polymyalgia rheumatica is associated with another inflammatory condition known as giant cell arteritis. About 10% to 20% of people with polymyalgia rheumatica may also have giant cell arteritis. Giant cell arteritis causes headaches, blurred vision, jaw pain, and tenderness on the scalp.
Symptoms
Polymyalgia rheumatica typically presents with sudden pain and stiffness in large joints, notably shoulders and hips, but can also affect neck, arms, back, and buttocks, often appearing within two weeks, sometimes overnight, and typically impacting both sides of the body.
Other common signs and symptoms include:
- Stiffness in the affected areas, particularly in the morning or after rest
- Restricted mobility in affected parts
- Stiffness, or pain in the knees, elbows, or wrists
- Weakness
- Overall malaise, or general sense of illness
- Low-grade fever
- Depression
- Decreased appetite
- Weight loss
If any of the signs and symptoms persist, consult a healthcare provider for proper diagnosis and treatment. Medical consultation is also necessary if one experiences new aches, pains, or stiffness that disrupt sleep or hinder one’s ability to perform daily tasks like getting dressed.
Since polymyalgia rheumatica and giant cell arteritis have overlapping symptoms, consult a healthcare provider if headaches, vision changes, fever, fatigue, loss of appetite, jaw pain, or tenderness around the scalp is experienced.
Causes
The exact origins of polymyalgia rheumatica remain uncertain, although researchers have suggested various theories. These encompass autoimmune disease, where the immune system erroneously targets the body, inflammation of sacs in the hips or shoulders, referred to as bursitis, and the effects of aging.
Other identified potential causes include:
- Heredity: The risk to polymyalgia rheumatic is often influenced by some genetic factors.
- Environmental exposure: Polymyalgia rheumatica has not been associated with any specific viral infection. However, many cases exhibit cyclical patterns and potential seasonal variations, suggesting a possible involvement of a virus or other environmental trigger.
- Giant cell arteritis: Polymyalgia rheumatica and giant cell arteritis often coexist and share similar symptoms. Giant cell arteritis causes inflammation in artery linings, especially in temples, leading to headaches, jaw pain, vision issues, and scalp tenderness. Without treatment, it can cause serious complications like stroke or blindness.
Risk factors
Although the exact cause of polymyalgia rheumatica is unknown, several risk factors were identified, such as:
- Age: It is most common in those who are 70 to 80 years old. Generally, as people age, the risk also increases.
- Sex: Polymyalgia rheumatica is more common in women than in men.
- Ethnic and racial background: Compared to any other ethnic or racial group, Caucasians, particularly those with Northern European origin are more susceptible to the disease.
Diagnosis
The diagnosis of polymyalgia rheumatica can be challenging because its symptoms overlap with other conditions like rheumatoid arthritis, spondyloarthritis, pseudogout, myositis, and connective tissue diseases.
The diagnostic process typically involves asking about one’s medical history and conducting a physical exam, which may involve gentle movements of the head and limbs to see how well one can move. The healthcare provider will focus on typical polymyalgia rheumatica signs and symptoms while considering other potential illnesses.
Tests may be required to further understand the source of the discomfort and stiffness. These tests may include:
- Blood tests: Despite the absence of a specific test for diagnosing polymyalgia rheumatica, indicators such as erythrocyte sedimentation rate (sed rate) and C-reactive protein, in addition to examining complete blood counts, also help identify signs of inflammation, aiding in the diagnosis and management of polymyalgia rheumatica.
- Imaging tests: MRI scans can help identify alternative causes of shoulder pain, such as joint issues. Ultrasounds and other imaging tests can also assist in distinguishing polymyalgia rheumatica from other conditions with similar symptoms.
- Biopsy of the artery in the temple: A biopsy involves removing a small sample of the artery for examination under local anesthesia to look for signs of inflammation. This is often recommended if the healthcare provider suspects giant cell arteritis, which is sometimes associated with polymyalgia rheumatica. Giant cell arteritis is a condition that can cause serious complications if not treated promptly.
Treatment
Treatment for polymyalgia rheumatica typically leads to symptom improvement. This treatment regimen may extend for one to two years, although in some cases, it may need to be prolonged further, particularly in instances of relapse.
Treatment options may include:
- Medications
- Corticosteroids: Treatment for polymyalgia rheumatica starts with a low dose of a medication called corticosteroids. If the symptoms get better, the dosage of the steroid is slowly reduced over one to two years. Sometimes, the symptoms might come back, and one may need to take a low dose of steroids for a longer time to prevent flare-ups.
Regular check-ups is necessary to assess treatment effectiveness and monitor for side effects such as weight gain, bone density loss, high blood pressure, diabetes, and cataracts.
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- Vitamin D and calcium: These supplements help prevent bone loss while on corticosteroid treatment. This is often recommended for people taking corticosteroids for more than three months. The recommended doses are about 1,000 to 1,200 milligrams of calcium and 600 to 800 international units of vitamin D.
- Methotrexate: This may be prescribed at the beginning of the treatment or later if there is an occurrence of relapse or inadequate response to corticosteroids. Methotrexate, a pill that suppresses the immune system, may be recommended for some patients along with corticosteroids.
- Physical therapy: In general, many individuals undergoing corticosteroid treatment for polymyalgia rheumatica can resume their usual activities. Individuals with polymyalgia rheumatica who have been less active may be advised to engage in regular physical activity. Maintaining muscle strength and joint flexibility is crucial, and recommended exercises include using a stationary bike, swimming, and walking. These activities not only enhance overall fitness but also aid in alleviating symptoms associated with the condition.
