What is Polymyalgia Rheumatica?

Polymyalgia rheumatica (PMR) is an inflammatory disease that causes pain and stiffness in the hips and shoulders. In most cases, the pain and stiffness is worse in the mornings.

In about 50% of people who get polymyalgia rheumatica, it goes away in a few months to a few years. In this case, it’s called a self-limited disease. However, in other patients, PR can be a long-term condition.

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Quiz: Do You Understand Polymyalgia Rheumatica?

Test your knowledge by answering the following questions:

Questions
True
False
1

Polymyalgia rheumatica usually occurs slowly over time.

Explanation:
Polymyalgia rheumatica often occurs suddenly, causing pain and stiffness, generally in the shoulder and hip girdle, extending into the upper arms, thighs and the back of the legs.
2

Polymyalgia rheumatica can occur in tandem with temporal arteritis.

Explanation:
PMR can occur in tandem with temporal arteritis, a condition that causes inflammation of the arteries on the temples, causing pain or headaches.
3

Polymyalgia rheumatica treatments include prednisone to get the inflammation under control.

Explanation:
Polymyalgia rheumatica treatments include 10 to 20 milligrams of prednisone daily to get the inflammation under control, after which your dosage will be reduced.
4

Disease-modifying anti-rheumatic drugs are not a good treatment for polymyalgia rheumatica.

Explanation:
Other PMR medications include non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs) and analgesics like acetaminophen.
5

Polymyalgia rheumatica goes away in a few months or years in only 10 percent of people affected.

Explanation:
Polymyalgia rheumatica goes away in a few months or years in approximately half the people affected. In individuals who respond to treatment and are able to taper and discontinue treatment over time, there is a relapse rate approaching 30 to 40 percent over a lifetime.
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Treatment of Polymyalgia Rheumatica

Who Gets Polymyalgia Rheumatica?

Most commonly, people over the age of 50 develop polymyalgia rheumatica. It’s more common for women to get polymyalgia rheumatica than men. Another condition called giant cell arteritis (also known as temporal arteritis) may occur with PR.

Approximately 15 out of every 100 people with polymyalgia rheumatica also have temporal arteritis. Temporal arteritis is a form of vasculitis (inflammation of the blood vessels). People with temporal arteritis have inflammation of the arteries along the temples. Symptoms include headaches, sensitivity, headaches and pain in the temples. In more severe cases patients may experience blurry vision or vision loss.

Causes of Polymyalgia Rheumatica

Health experts aren’t sure what causes polymyalgia rheumatica, or why it may be a short-term or long-term disease. Some doctors believe that it’s caused by an external factor (a virus) that triggers the immune system.

Dr John Watterson, MD, FRCPC, discusses what polymyalgia rheumatica is.

Similarities to Other Diseases

Polymyalgia rheumatica can be mistaken for rheumatoid arthritis (RA), another type of inflammatory arthritis, because it also start in the joints of the shoulders.

However, rheumatoid arthritis isn’t like polymyalgia rheumatica, as more joints generally become affected in patients who have RA. In polymyalgia rheumatica, the joints surrounding the shoulders and the hips are affected.

Other types of conditions such as cancer, thyroid conditions and heart conditions may look like polymyalgia rheumatica, but are not related to arthritis.

Diagnosis of Polymyalgia Rheumatica

A rheumatologist is a physician who specializes in treating arthritis and autoimmune disease. Because other diseases can be similar to polymyalgia rheumatica, it’s important to work with a doctor who understands the condition.

In order to diagnose polymyalgia rheumatica, your physician will start by taking a complete medical history and physical assessment. Often, the doctor will order blood tests and x-rays to confirm the diagnosis.

Symptoms of Polymyalgia Rheumatica

The most common symptom of polymyalgia rheumatica are intense pain and stiffness in the shoulders and hips. Generally, PR comes on suddenly, sometimes even overnight.

Patients often feel their stiffness is worse in the morning or after resting. Some people feel better once they get moving, while others feel pain and stiffness throughout the day.

Treatment of Polymyalgia Rheumatica

When it comes to treating polymyalgia rheumatica, the earlier the better. If a person with untreated polymyalgia rheumatica simply stops using their sore joints to minimize pain and stiffness, it can lead to contracture, which is a type of permanent damage that shortens the affected muscle or joint.

For most patients, treatment of polymyalgia rheumatica involves medications that deal with inflammation. Medications for polymyalgia rheumatica include:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs help reduce the pain and inflammation caused by polymyalgia rheumatica. While not as effective as prednisone for the initial treatment of PR, but can be effective when used with prednisone.

Nonsteroidal anti-inflammatory drugs can also help reduce the dose of prednisone in patients who have been taking the medication for a long time.

Disease Modifying Anti-Rheumatic Drugs (DMARDs)

DMARDs are medications that are often used for inflammatory arthritis such as rheumatoid arthritis (RA). A rheumatologist may prescrbe a medication such as methotrexate to treat polymyalgia rheumatica.

as well as physical therapy to keep the joints moving properly. The disease can often by fully and effectively treated with the right therapy, which means it’s possible for people affected by the disease to return to their normal day-to-day lives.

Analgesics (Pain Killers)

Analgesic medications can be effective in controlling pain, but they don’t do control PR or prevent further joint damage. Analgesics include over-the-counter options like acetaminophen or stronger prescription narcotics like morphine.

Corticosteroids (Prednisone)

Prednisone is the most common medication used to treat polymyalgia rheumatica, which fights inflammation. Most patients who take prednisone feel better within 24 hours, and the dose is gradually reduced over time. Most patients continue taking a low dose of prednisone for at least a year to treat inflammation.

If you’re taking prednisone for three months or longer, you may require a daily calcium and vitamin D supplement to protect your bones.

Your rheumatologist may recommend other medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or disease modifying anti-rheumatic drugs (DMARDs).

In addition to medications, patients may benefit from physical therapy and exercise for polymyalgia rheumatica. Exercise and stretching can improve pain and stiffness in the shoulders and hips and protect the joints from further damage.

Daily exercise can also help people manage fatigue and mental health associated with PR.

 

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