Polymyalgia rheumatica

This little known form of arthritis is an inflammatory condition which affects the muscles and tissues of the joints. It causes symptoms such as soreness, pain and stiffness which are a common feature of conditions such as rheumatoid arthritis and osteoarthritis.

Polymyalgia rheumatica (PMR) can not be cured but there is treatment available to ease the symptoms and prevent any relapses.

It is difficult to pinpoint the precise cause of PMR but experts believe there are a couple of possible causes which include a malfunction within the immune system and a genetic link.

Polymyalgia rheumatica is discussed in the following manner within this section:

• Who is most likely to develop polymyalgia rheumatica?
• How does polymyalgia rheumatica occur?
• Causes of polymyalgia rheumatica
• Symptoms of polymyalgia rheumatica
• Diagnosis of polymyalgia rheumatica
• Treatment for polymyalgia rheumatica
• Managing polymyalgia rheumatica
• What is giant cell arteritis?

Who is most likely to develop polymyalgia rheumatica?

It affects around 1 in 2,000 people in the UK. It tends to affect people over 65, the most common age being 70. Three times as many women are affected compared to men.

(Source: Arthritis Research UK).

How does polymyalgia rheumatica occur?

This is difficult to say but it appears to be the case that something goes wrong in the immune system which causes it to attack healthy tissues around the joints.

There are people who develop polymyalgia rheumatica who then develop a similar condition called ‘giant cell arteritis’.

Do not confuse this with ‘arthritis’ even though it has a similar spelling. Giant cell arteritis is discussed separately at the end of this section.

Causes of polymyalgia rheumatica

The causes of this arthritis are unknown. But, there are two possible causes which are:

• Fault in the immune system
• Genetics/environment

Fault in the immune system

There is evidence to show that polymyalgia rheumatica is caused by a fault within your immune system which causes it to turn upon your body. Your immune system releases white blood cells to attack the lining of your joints which results in inflammation, pain and stiffness.

Experts are unsure as to what triggers this reaction in the immune system which is also responsible for rheumatoid arthritis and many other conditions.

Genetics/environment

Polymyalgia rheumatica affects white people more than any other ethnic group which suggests a genetic link. Plus it also affects people in certain geographical areas of the country, for example above average rates in the South East of the UK.

Not a great deal is known about this condition: but what are known are certain risk factors for polymyalgia rheumatica such as gender, age and ethnicity.

Symptoms of polymyalgia rheumatica

These either develop slowly over a long period of time or appear within a matter of weeks. Many people dismiss these as the normal aches and pains associated with growing old and only take action when these symptoms reach a severe stage.

The two most common symptoms are pain and stiffness in the muscles which vary from a moderate intensity through to severe. These usually affect the muscles in the shoulder and neck although some people experience these symptoms in the hips, thighs and lower back.

This pain is at its worst first thing in the morning. You will notice it when you get out of bed, walk up the stairs or when lifting your arms above shoulder height. Getting dressed is also difficult.

This pain lasts for around 30 minutes to an hour but eases once you move around and continues to do for the rest of the day.

This may be accompanied by other symptoms which include:

• Extreme tiredness
• Mild fever
• Lack of appetite
• Weight loss
• Depression
• Night sweats

Your joints may be inflamed with the inflammation spreading to the tendons, causing ‘tenosynovitis’. This is often seen as a swelling in the hands or feet.

If you experience headaches, blurred/double vision and pain down one side of the face then seek urgent medical advice. These are symptoms of giant cell arteritis which if left untreated can lead to damage to arteries within the eye.

Diagnosis of polymyalgia rheumatica

Your GP will use several procedures to confirm or reject a diagnosis of polymyalgia rheumatica. These include a physical examination, questions about your medical history and a series of blood tests.

A blood test is a commonly performed test in many cases of arthritis; and because the symptoms of this condition mimic several other types of arthritis he/she will want to rule these out before deciding upon your treatment.

The bird criteria

Your GP will use a set of criteria known as the ‘Bird Criteria’which states that a patient may have polymyalgia rheumatica if they fulfil three or more of these criteria.

They include:

• You are aged 65 and above
• You have pain and stiffness in both your shoulders
• Your symptoms have developed in the last two weeks
• You have symptoms of pain and soreness in both your arms
• You experience stiffness first thing in the morning which lasts for an hour or longer.
• You have lost weight
• You have symptoms of depression

In regard to the criteria about your age: this arthritis can affect people over 50 but is more likely to occur in the over 65’s.

Blood tests

There are three blood tests which are used to diagnose polymyalgia rheumatica which are:

• Plasma viscosity (PV)
• C-reactive protein (CRP)
• Erythrocyte sedimentation rate (ESR)

Plasma viscosity test is used to measure the amount of protein in plasma as part of the blood. A high level of protein is an indicator of an inflammation such as rheumatoid arthritis or polymyalgia rheumatica.

The C-reactive protein test works in a similar way. It is used to detect the presence of any inflammation in the body which suggests a form of arthritis.

The erythrocyte sedimentation test looks at how quickly red blood cells settle when placed in a test tube. If they settle quickly then it is a sign that your immune system has caused an inflammation.

If the diagnosis is still unconfirmed then you may undergo additional tests such as an ultrasound scan of the affected areas, e.g. neck and shoulders.

If you are diagnosed with polymyalgia rheumatica then this can be treated by your GP although you may be referred to a rheumatologist if there is a likelihood of complications.

Treatment for polymyalgia rheumatica

The main treatment for this is corticosteroids, a powerful and effective form of medication. One example of this medication is prednisolone.

This type of medication works by reducing inflammation within the body and is considered more effective than standard pain relief in these cases. You will take this for two to three years to ensure that they have fully dealt with your symptoms.

Do not stop taking your steroid treatment until otherwise directed by your GP.

Some people have to take corticosteroids for the rest of their life.

Do not take ordinary painkillers such as anti-inflammatory drugs, e.g. Ibuprofen whilst taking steroids. Ask your GP for advice before you do so as there are risks with combining these two drugs.

Corticosteroids help to reduce any inflammation in the joints and other areas of the body. But they do reduce your immunity to infection especially viral infections and have side effects which include acne, muscle weakness and weight gain.

You may be prescribed another set of drugs called immunosuppressants which help to regulate the symptoms of polymyalgia rheumatica. But these are only prescribed to people who have experienced several relapses of their condition.

Your GP will monitor your condition to check your progress and the chance of a relapse. Corticosteroids do not cure this condition but are effective at reducing inflammation although this must continue for a period of two years or more.

Find out more in our treatment for arthritis section.

Managing polymyalgia rheumatica

It is important to realise that any steroid treatment has a risk of side effects which include increased appetite and weight gain. So try and reduce the risk of these by following a healthy diet, managing your weight and taking exercise.

Choose a weight bearing exercise such as running or walking but avoid overdoing it as this will worsen your symptoms. Strike a balance between exercise and rest.

Increase the amount of calcium in your diet as steroids tend to reduce the amount of calcium absorbed by your body. Milk is a good source of calcium as is cheese and yoghurt. Ensure that you ingest enough Vitamin D as this helps with the absorption of calcium.

Good examples of Vitamin D enriched foods include oily fish, milk and eggs.

Stop smoking if you are a smoker and have a mild to moderate alcohol intake. Too much alcohol increases your risk of conditions such as osteoporosis.

Keep moving through the day. Avoid sitting down for a long time but if you do then get up and stretch your legs at intervals. Have a hot shower or bath in the mornings and after exercise as this will ease any pain and stiffness.

Keep a note of your steroid treatment on your person. This could be a small card which shows what drug you are taking, the dosage and how long. This is useful if you are away on holiday or in case of emergencies.

For more information about these and other ways of coping with arthritis then visit our living with arthritissection.

What is giant cell arteritis?

This is also known as ‘temporal arteritis’: giant cell arteritis (GCA) affects a certain percentage of people who develop polymyalgia rheumatica although it is much less common.

Risk factors for GCA are the same as those for polymyalgia rheumatica.

It causes an inflammation of the arteries within the sides of the forehead which are close to the eyes. As a result of this there is the risk of it affecting the eyes which may in some cases lead to blindness.

It can even affect arteries to the brain although this is very rare.

Symptoms of this include headaches; weakness or numbness in the side of the face, double vision; pain in the jaw; swelling in the scalp and soreness around your forehead.

If you have polymyalgia rheumatica and develop any of these symptoms then see your GP as soon as possible. Giant cell arteritis can be treated with a higher dose of steroids but it is important that this happens sooner rather than later to avoid permanent damage to the eyes.