Polymyalgia Rheumatica

Polymyalgia rheumatica causes severe pain and stiffness in the muscles of the neck, shoulders, and hips.

Polymyalgia rheumatica occurs in people older than 50 and is twice as common in women as in men. Its cause is not known. Because polymyalgia rheumatica may occur with temporal (giant cell) arteritis, it is suggested that the two disorders may develop in the same way.

Symptoms and Diagnosis

Polymyalgia rheumatica causes severe pain and stiffness in the neck, shoulders, and hips. The stiffness is worse in the morning and after periods of inactivity. A fever, vague discomfort, weight loss, and depression may accompany the muscle symptoms. All these symptoms may develop suddenly or gradually. Muscle damage or weakness does not occur. Some people with polymyalgia rheumatica also develop symptoms of temporal arteritis, which can lead to blindness. Some people may have mild arthritis, but if the arthritis is prominent, rheumatoid arthritis (see Section 5, Chapter 67) is more likely to be the diagnosis.

A doctor makes the diagnosis on the basis of the person's symptoms, physical examination, and test results. Blood test results, such as the erythrocyte sedimentation rate (ESR) and C-reactive protein, are usually very high, indicating active inflammation. Biopsies of muscle tissue are usually not needed but, if performed, show no evidence of muscle damage; electromyography (see Section 6, Chapter 77) shows no abnormalities. Blood tests may detect anemia.

Treatment

Polymyalgia rheumatica usually improves dramatically with low doses of prednisone, a corticosteroid. When temporal arteritis also occurs, higher doses of a corticosteroid are needed, particularly to reduce the risk of blindness. As the symptoms subside, the dose is gradually reduced to the lowest effective one. Many people can stop taking prednisone in 2 to 4 years, although some people need low doses for an even longer time. Aspirin or other nonsteroidal anti-inflammatory drugs may provide less relief.