Polymyalgia Rheumatica Overview
With proper treatment, symptoms of PMR generally improve within one to two days. But relapse is common, so patients may have to stay on therapy for up to 2 years, and sometimes longer.
You wake up one morning and your shoulders and hips ache all over. The possible cause is polymyalgia rheumatica (PMR), a common cause of widespread pain and stiffness that mostly affects older women.
PMR almost always occurs in people over age 50. The average age when symptoms start is 70. It is more common in women. Some people develop PMR overnight, while in other people it occurs gradually. The cause is not known.
Some people with PMR also develop another condition called giant cell arteritis, which causes inflammation of the arteries in the head. Symptoms of giant cell arteritis may include headaches, jaw pain with chewing food and vision changes (double vision, loss of vision, or blurred vision).
With treatment, symptoms of PMR generally improve within one to two days. However, the treatment course is prolonged, as many patients experience recurrent symptoms over time.
Symptoms and Diagnosis of Polymyalgia Rheumatica
There is no single test to diagnose PMR. Your doctor will use your medical history, physical exam and your symptoms to make the diagnosis. Lab tests may be used to look for inflammation, which can help your doctor confirm the diagnosis.
Symptoms of PMR are stiffness and muscle aches in the neck, shoulders and hips. They are most severe in the morning. The achiness tends to improve as the day goes on. Inactivity, such as sitting in the car for a long time or sitting too long in one position, can cause symptoms to return.
Symptoms can also occur in the upper arms, lower back and thighs. They tend to come on quickly in most people, and affect both sides of the body.
Other PMR symptoms include:
- Fatigue (may be related to anemia)
- Appetite loss, which leads to weight loss
- Low grade fever
PMR can cause:
- Difficulty raising the upper arms above the shoulders
- Disturbed sleep
- Difficulty getting dressed (such as bending over to put on socks and shoes, or putting on a jacket)
- Problems getting in and out of a car or getting up from a sofa
There is no definitive test to diagnose PMR. In 2012, the American College of Rheumatology, in conjunction with the European League Against Rheumatism, released provisional classification criteria for PMR. These criteria are not considered official for the diagnosis of PMR, but may help to determine if you have PMR or another rheumatological disorder. They include:
- 50 years of age or older
- Shoulder pain in both shoulders that is not better explained by an another diagnosis
- Morning stiffness lasting more than 45 minutes
- Elevated blood test for inflammation (see below)
- New hip pain
Your doctor will order blood tests to look for inflammation. In people with PMR, results of these tests may be abnormally high. Two tests used to help diagnose PMR are the erythrocyte sedimentation rate (known as the "sed rate”) and C-reactive protein (CRP). The erythrocyte sedimentation rate checks how quickly red blood cells fall to the bottom of a test tube. This indicates whether inflammation is present. C-reactive protein measures general levels of inflammation in the body. A high concentration of C-reactive protein indicates increased inflammation.
MRI or ultrasound may be used to look for inflammation of tissues in the shoulder and hip joints.
Because PMR can be hard to diagnose, your doctor may do other testing to rule out other health problems such as rheumatoid arthritis. Blood tests for this condition include a rheumatoid factor (RF) and an anti-citrullinated protein antibody (ACPA). These antibodies are often present in people with rheumatoid arthritis but generally are not found in the blood of people with PMR.
Up to 25% of people with PMR also develop giant cell arteritis, which is a form of blood vessel inflammation (vasculitis). A biopsy from the artery in the temple is required to confirm a diagnosis of giant cell arteritis. Because untreated giant cell arteritis can cause blindness, doctors generally begin treatment before obtaining a biopsy. Giant cell arteritis may lead to vision loss, stroke or an aortic aneurysm (a potentially life-threatening bulge in the large artery that runs down the center of the chest and abdomen).