Polymyalgia rheumatica (PMR) is an inflammatory condition that can cause aching and stiffness. It tends to affect the neck, shoulders, and hips. The aching and stiffness are usually worse in the morning.
PMR can come on suddenly. For some, it seems to happen overnight. For others, it can take days or weeks to develop. PMR only affects older adults. It becomes more common with age. PMR happens most often between the ages of 70 and 80. It can be seen as early as 50 years of age. It's more common in women than in men, and it seems to run in some families.
Researchers are working to understand the causes of PMR. Because it can happen quickly and tends to happen at certain times of year, some think that an infection may cause it. Genes may be part of the cause. PMR can run in some families.
Some factors seem to increase the risk of polymyalgia rheumatic. These include:
Older age (age 50 or older)
Being Caucasian, especially of Scandinavian descent
The main symptoms of PMR are aching and stiffness of the shoulders, neck, and hips. The aching can extend to the upper arms and thighs. PMR tends to affect both sides of the body equally. Symptoms are often worse in the morning or after long periods of no activity. Movement can make the pain worse.
The symptoms of PMR usually affect the shoulders the most. You may have trouble raising your arms above the level of your shoulders. This can make it hard to get dressed. You may have trouble rolling over in bed, getting out of bed, and getting up from sitting. You may also have trouble sleeping because of your symptoms.
Other symptoms can happen, such as:
Swelling of the hands, wrists, feet, and ankles
Numbness, tingling, or pain in the hand, wrist, or forearm
Feeling of weakness
General feeling of being unwell
Loss of appetite
Some people with PMR also have a condition called giant cell arteritis, also called temporal arteritis or Horton arteritis. This is inflammation of blood vessels in the head, neck, and arms. This can narrow or block the blood vessels. It can cause problems from less blood flowing through those vessels. Giant cell arteritis can cause symptoms such as:
Changes in vision
Jaw pain, especially when chewing
Scalp sores (ulcers)
Your healthcare provider will ask about your health history and your symptoms. They will give you a physical exam. The exam will check your range of motion, strength, and painful areas.
Diagnosing PMR can be difficult. Your healthcare provider will need to make sure you have PMR. Many conditions can cause aching and stiffness. These include rheumatoid arthritis, myositis, and fibromyalgia. You may need tests, such as
Blood tests to look for signs of inflammation, blood count problems, and muscle damage
Muscle biopsy to check for damage
X-rays to look at your joints
MRI for detailed pictures of your joints and tissues
Ultrasound scans to look closely at the soft tissues surrounding your joints
If your healthcare provider suspects giant cell arteritis they may do the following tests:
Ultrasound of the temporal and axillary arteries
Biopsy of temporal artery (blood vessel in the temple
Your healthcare provider may also diagnose you by giving you medicine. PMR often responds quickly to steroid medicine. This can help show if you have PMR. You may also be referred to a rheumatologist for diagnosis.
Steroid medicine is the main treatment for PMR. Your healthcare provider will start you on a low dose of this medicine. You should start to feel better soon after starting. When your symptoms are better, your healthcare provider will slowly lower the amount of medicine. If your symptoms return, they will increase the dose. You may need to take steroids for a few years. Return of symptoms is common, so you may need to take steroids again in the future. If untreated, PMR may go away on its own after several years. But symptoms will likely return.
Polymyalgia rheumatica doesn’t have any specific complications. But possible complications of giant cell arteritis may include blindness or stroke. Giant cell arteritis can also be treated with steroids.
Steroids have some risks. Talk with your healthcare provider about the risks and benefits for you. Some of the possible risks of taking steroids for a long time can include:
High blood pressure
Thinning bones (osteoporosis/osteopenia)
Roundness of the face
Poor wound healing
Increased infection risk
If you have PMR, your symptoms will get better with treatment. Once you start feeling better, you can return to your normal activities. Your healthcare provider will track your symptoms and adjust your steroid dose until you are on the lowest dose needed. Small changes in steroid doses can have a big effect on your symptoms. Make sure to follow your healthcare provider’s instructions.
Call your healthcare provider if you have any of the following:
Symptoms that don’t get better with treatment
Symptoms that get worse
Symptoms of giant cell arteritis
Loss of part of a visual field for any duration of time
Call 911 if you have symptoms of a stroke, such as:
Balance or coordination problems
Weakness or numbness
If you think you are having a stroke, note the time when your symptoms started.
PMR is an inflammatory condition.
Common symptoms include aching and stiffness of the neck, shoulders, and hips. These symptoms are usually worse in the morning.
PMR only affects older adults.
Some people who develop PMR also develop giant cell arteritis.
The specific causes of PMR and giant cell arteritis are unknown.
Both conditions get better with steroid therapy.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.