What is polymyalgia rheumatica?
Polymyalgia rheumatica (PMR) is a condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips.
Polymyalgia rheumatica may also cause other symptoms, including:
- a high temperature (fever)
- extreme tiredness (fatigue)
- loss of appetite
- weight loss
If you have pain and stiffness that lasts longer than a week, you should see your doctor so the cause can be investigated.
It can be difficult to diagnose polymyalgia rheumatica because it has symptoms similar to many other conditions, such as rheumatoid arthritis. These conditions will need to be ruled out before polymyalgia rheumatica is diagnosed.
How is it treated?
The main treatment for the condition is a steroid medication (corticosteroids called prednisolone, which is used to help relieve your symptoms.
You will initially be prescribed a high dose of prednisolone, which will be reduced gradually over time.
Most people with polymyalgia rheumatica will need to take a long-term course of corticosteroid treatment (lasting one to two years) to prevent their symptoms returning.
Read more about treating polymyalgia rheumatica.
Who is affected?
Polymyalgia rheumatica is relatively common.
Polymyalgia rheumatica is an age-related condition. Most people diagnosed with the condition are over 70 years old and cases affecting people younger than 50 are almost unheard of.
The condition is two to three times more common in women than men. It is more widespread among white people, particularly those of northern European descent.
The cause of polymyalgia rheumatica is unclear. However, it is thought that a combination of genetic and environmental factors is responsible.
Polymyalgia rheumatica symptoms
The most common symptom of polymyalgia rheumatica (PMR) is pain and stiffness in the shoulder muscles which develops quickly over a few days or weeks.
The muscles in the neck and hips are also often affected.
You may only notice pain and stiffness in one side of your body at first, but both sides are usually affected as the condition progresses.
The stiffness usually feels worse first thing in the morning after you wake up and starts to improve after about 45 minutes as you become more active.
Some people with polymyalgia rheumatica have additional symptoms, including:
- a mild high temperature (fever) of 37-38°C (98.6-100.4°F)
- fatigue (extreme tiredness)
- loss of appetite
- weight loss
When to seek medical advice
If you have symptoms of pain and stiffness that last longer than a week, you should make an appointment to see your doctor so that the cause can be investigated.
When to seek immediate medical advice
You should seek immediate medical advice if you have been diagnosed with polymyalgia rheumatica (or the condition is suspected) and you suddenly develop:
- a persistent and severe headache
- jaw pain or cramping in your jaw muscles which is worse when you are eating
- vision loss or vision disturbances, such as double vision
These symptoms may indicate a more serious condition called giant cell arteritis (temporal arteritis).
If you have any of the above symptoms, call your doctor immediately for advice. If this is not possible, call your local out of hours service.
Diagnosis polymyalgia rheumatica
Diagnosing polymyalgia rheumatica (PMR) can often be quite a lengthy process that involves several different tests.
This is because the condition shares many symptoms with more common health conditions, such as rheumatoid arthritis, which need to be ruled out first.
It is likely that a series of blood tests will be carried out.
Blood tests called erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) are usually used to check the levels of inflammation in your body.
Blood tests can also determine:
- whether there is an infection in your blood
- how well some of your organs, such as your kidneys, are working
- whether you have an overactive thyroid gland or an underactive thyroid gland (both conditions can cause muscle pain)
After other possible causes of your symptoms have been ruled out, a checklist can be used to see whether your symptoms match those most commonly associated with polymyalgia rheumatica.
According to the most widely used checklist, a very confident diagnosis of polymyalgia rheumatica can be made if you meet all of the following criteria:
- you are over 50 years old
- you have pain in your shoulders or your hips
- you have stiffness in the morning that lasts longer than 45 minutes
- your symptoms have lasted longer than two weeks
- blood tests show raised levels of inflammation in your body
- your symptoms improve rapidly after being treated with corticosteroids (see treating polymyalgia rheumatica for more information)
Treatment for polymyalgia rheumatica
Steroid medication (corticosteroids) is the preferred treatment for polymyalgia rheumatica (PMR). A type of corticosteroid called prednisolone is usually prescribed.
Prednisolone works by blocking the effects of certain chemicals that cause inflammation inside your body. It does not cure polymyalgia rheumatica, but it can help relieve the symptoms.
When used to treat polymyalgia rheumatica, prednisolone is taken orally. Most people will be prescribed several tablets to take once a day.
You will be prescribed a high dose of prednisolone initially and the dosage will be gradually reduced every one to two months.
Although your symptoms should improve significantly within a few days of starting your treatment, you will probably need to continue taking a low dose of prednisolone for about two years.
In many cases, polymyalgia rheumatica improves on its own after this time. However, there is a chance that the condition will return (relapse) once treatment stops.
Do not suddenly stop taking steroid medication, unless told by a doctor that it's safe to do so. Suddenly stopping treatment with steroids can make you feel very ill.
About one in 20 people who take prednisolone will experience changes in their mental state when they take the medication.
For example, you may feel very depressed and suicidal, very anxious or very confused. Some people also experience hallucinations (feeling, seeing or hearing things that are not there). Contact your doctor as soon as possible if you experience changes to your mental state.
Other side effects of prednisolone include:
- increased appetite that often leads to weight gain
- increased blood pressure
- mood changes, such as becoming aggressive or irritable with people
- weakening of the bones (osteoporosis)
- stomach ulcers
- increased risk of infection, particularly the virus that causes chickenpox and shingles (varicella-zoster virus)
Seek immediate medical advice if you think that you have been exposed to the varicella-zoster virus or if a member of your household develops chickenpox or shingles.
The risk of these side effects should improve as your dosage of prednisolone is decreased.
See side effects of corticosteroids for more information about how these side effects may affect you and how they are treated.
Sometimes, other medications may be combined with corticosteroids to help prevent relapses or to allow your dose of prednisolone to be reduced.
Some people are prescribed immunosuppressant medication, such as methotrexate. This is used to reduce or suppress the immune system (the body's defence against illness and infection). It may be helpful for people with polymyalgia rheumatica who have frequent relapses or don't respond to normal steroid treatment.
Your doctor may recommend painkillers such as paracetamol to help relieve pain while your dose of prednisolone is reduced.
Your doctor will ask you to attend regular follow-up appointments so they can check how well you are responding to treatment, whether your dosage of prednisolone needs to be adjusted, and how well you are coping with the side effects of the medication.
During these appointments, you will have blood tests to check the levels of inflammation inside your body.
Follow-up appointments are usually recommended every few weeks for the first three months and then at three- to six-monthly intervals after this time.
If you experience a return of your symptoms during any part of your treatment, contact your doctor as your dosage may need to be adjusted.