Polymyalgia rheumatica

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The information below has been written for people affected by polymyalgia rheumatica. It provides general information to help you understand how you may be affected and what you can do to manage it. It also tells you where to find further information and advice.

What is polymyalgia rheumatica?
Polymyalgia rheumatica means ‘pain in many muscles’. It is a condition that causes inflammation of the joints and tissues around the joints. This causes muscles to feel painful and stiff, especially in the shoulder, neck and hip areas. Polymyalgia rheumatica is different to fibromyalgia, a condition that does not cause inflammation.

What are the symptoms?
The main symptoms are:

• muscle pain and stiffness in the upper arms, neck, buttocks and thighs on both sides of the body
• pain and stiffness worse in the morning, and after not moving, such as after a long car ride or sitting too long in one position
• difficulty sleeping and doing daily activities (for example, lifting the arms to put on a jacket, bending over to pull on shoes or getting up from a low chair) due to pain and stiffness.

Symptoms usually come on quickly, over several days or weeks and sometimes even overnight.

What causes it?
The exact cause of polymyalgia rheumatica is not known. Genetics and/or environmental factors, such as an infection, may play roles in causing this type of arthritis. This has yet to be proven in research.

How is it diagnosed?
There is no single test that can diagnose polymyalgia rheumatica. Your doctor will diagnose polymyalgia rheumatica from your symptoms, a physical examination and blood tests that measure levels of inflammation. These tests measure the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) blood level. However some people with polymyalgia rheumatica can have normal blood tests. It may take several visits before your doctor can tell if you have polymyalgia rheumatica as the symptoms can be like other types of arthritis.

What will happen to me?
The good news is that the symptoms of polymyalgia rheumatica usually improve with treatment. In fact, most people find their symptoms improve dramatically within a few days of starting treatment. It usually takes two to three years for polymyalgia rheumatica to settle completely. Most people will need to continue treatment during this time to keep the symptoms under control. Polymyalgia rheumatica can return, particularly when you stop treatment, however this is rare if you have been free of symptoms for some time.

What treatments are there for polymyalgia rheumatica?
Treatment for polymyalgia rheumatica usually involves medicines called corticosteroids. Your doctor will usually start you on a dose that relieves your symptoms, and then slowly reduce the dose to the lowest possible amount that keeps you symptom free. Corticosteroids can cause side effects so it is important to be reviewed regularly by your doctor while taking these medicines. For information about corticosteroids see the Australian Rheumatology Association’s Patient Medicine Information or the Medicines and arthritis information sheet.

What can I do?
See a doctor and start treatment.
Your doctor will make sure you get the right treatment to manage your symptoms. Your doctor may refer you to a rheumatologist, a doctor who specialises in arthritis, if your condition is difficult to control.

Learn about polymyalgia rheumatica and play an active role in your treatment. Not all information you read or hear about is trustworthy so always talk to your doctor or healthcare team about treatments you are thinking about trying. Reliable sources of further information are also listed in the section below. Self management courses aim to help you develop skills to be actively involved in your healthcare. Contact your local Arthritis Office for details of these courses.

Learn ways to manage pain. See the Dealing with pain information sheet.

Live a healthy life. Stay physically active, eat a healthy diet, stop smoking and reduce stress to help your overall health and wellbeing. See the Physical activity and Healthy eating information sheets.

Acknowledge your feelings and seek support. Having polymyalgia rheumatica can turn your everyday life upside down. As such it is natural to feel scared, frustrated, sad and sometimes angry. Be aware of these feelings and get help if they start affecting your daily life. See the Arthritis and emotions information sheet.

Giant cell arteritis
About one in five people with polymyalgia rheumatica may also develop a serious condition called giant cell arteritis or temporal arteritis. In this condition, the blood vessels, usually on the side of the head, become inflamed. It is diagnosed by looking at a small piece of blood vessel from your forehead (a biopsy) under a microscope. If it is not treated giant cell arteritis can cause permanent damage, such as blindness. If you have headaches, blurred or double vision, pain in the jaw muscles when chewing or the side of your head is sore to touch or swollen, you should see your doctor straight away.

Learn about polymyalgia rheumatica and your treatment options. There are effective treatments for polymyalgia rheumatica.

For more information:

Parker, James N (editor) & Parker, Philip M (editor) 2002, The official patient’s sourcebook on polymyalgia rheumatica: A revised and updated directory for the internet age, PICON Health Publications, San Diego CA.

Australian Rheumatology Association – information about medicines and seeing a rheumatologist www.rheumatology.org.au
The Arthritis Research Campaign www.arc.org.uk
American College of Rheumatology www.rheumatology.org
Arthritis Foundation (US) www.arthritis.org