Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) causes pains, stiffness and tenderness in large muscles. The cause is not known. Treatment with steroid tablets usually works very well to ease symptoms. You need to take a low dose of steroid tablets each day to keep symptoms away. Some people with PMR develop a related condition called giant cell arteritis which can be more serious.

What is polymyalgia rheumatica and who does it affect?

Polymyalgia rheumatica (PMR) is a condition which causes inflammation of large muscles. 'Poly' means many, and 'myalgia' means muscle pain. The cause of PMR is not known.

PMR mainly affects people over the age of 65. It is rare in people under 60. About 4 in 10,000 people over the age of 60 develop PMR each year. Women are three times more likely to be affected than men.

What are the symptoms of polymyalgia rheumatica?

• Usual symptoms are stiffness, pain, aching, and tenderness of the large muscles around your shoulders, pelvis, and back. The stiffness is usually worst first thing in the morning. Getting out of bed may be difficult. The stiffness often eases as the day goes on.
• Inflammation and swelling sometimes occurs in other 'soft tissues' of the body. For example, tendons may become inflamed (tenosynovitis), your hands or feet may become slightly swollen, and some joints may become slightly swollen.
• Other general symptoms may also occur. These include: tiredness, depression, night sweats, fever, loss of appetite, and weight loss.

Symptoms typically develop over a few days or weeks. However, they develop more slowly in some cases. You may pass it off as 'aches and pains of getting older' when symptoms first start.

Do I need any tests?

Symptoms of PMR are sometimes similar to other conditions such as frozen shoulder, arthritis, or other muscle diseases. A blood test helps to make the correct diagnosis. No blood test is 100% reliable for PMR. However, a blood test can detect if there is inflammation in your body. If the blood test shows a high level of inflammation, and you have the typical symptoms, then this usually confirms the diagnosis of PMR.

What is the treatment for polymyalgia rheumatica?

A steroid medicine such as prednisolone is the usual treatment. Steroids work by reducing inflammation. Treatment usually works quickly, within a few days. After starting treatment, the improvement in symptoms over 2-3 days is often quite dramatic.

Treatment is usually started with a medium dose - usually about 15 mg per day. This is then reduced gradually to a lower 'maintenance' dose. It may take several months to gradually reduce the dose. The maintenance dose needed to keep symptoms away varies from person to person. Usually it is between 5 and 8 mg per day.

You are likely to need treatment for at least two years. In some people the condition goes away, so the tablets can be stopped after 2-3 years. However, many people need treatment for several years, sometimes for life. If you stop taking the steroid tablets too soon, the symptoms return.

Some points about steroid tablets

• Do not stop taking steroid tablets suddenly. It probably does no harm if you forget to take the odd tablet. However, once your body is used to steroids, if you stop the tablets suddenly you may get serious withdrawal effects within a few days.
• Do not take anti-inflammatory painkillers whilst you take steroids unless advised by a doctor. The two together increase your risk of developing a stomach ulcer.
• Most people who take regular steroids carry a 'steroid card'. This gives details of your dose, condition, etc, in case of emergencies.
• If you are ill with other conditions, or have surgery, the dose of steroid may need to be increased for a short time. This is because you need more steroid during physical stress.

Side-effects
The risk of developing side-effects from steroids is increased with higher doses. This is why the dose used is the lowest that keeps symptoms away. If possible, a maintenance dose below 7-10 mg per day is best. Most people with PMR need less than 10 mg per day to keep symptoms away. Possible side-effects from steroids include the following.

• Osteoporosis ('thinning of the bones') - but you can take a medicine to help protect against this if you are at increased risk (for example, if you are 65 or older, or have a history of fractures). Your doctor will advise.
• Weight gain.
• Increased chance of infections - in particular, a severe form of chickenpox. However, most people have had chickenpox in the past and are immune to it. If you have not had chickenpox, keep away from people with chickenpox or shingles. Tell a doctor if you come in contact with anyone with these conditions if you have not had chickenpox in the past.
• Increase in blood pressure. Therefore, have your blood pressure checked regularly.
• High blood sugar.

Although the above points have to be mentioned, do not be put off about steroids. Most people with PMR feel so much better after starting steroid tablets. The relief of symptoms usually outweighs the risk of side-effects from the doses of steroids used for this condition.

Are there any complications with polymyalgia rheumatica?

About 1 in 20 people on treatment for PMR (and about 7 in 20 with untreated PMR) develop giant cell arteritis (temporal arteritis). This is a related condition which causes inflammation of arteries (blood vessels). The arteries most commonly affected are those which pass over the temples (the sides of the forehead next to the eyes). The eye can be affected in some cases. This can lead to serious eye problems, even blindness. Rarely, other arteries such as those going to the brain are affected.

If you develop giant cell arteritis, you should start treatment as soon as possible after symptoms develop. It is treated with a much higher dose of steroids than PMR.

So, tell a doctor urgently if you have PMR and you develop any of the following symptoms.

• Headache or tenderness on one side of your head.
• Pain in your jaw when you chew which eases quickly when you rest the jaw muscles.
• Sudden loss of vision, or any other sudden visual problem in one eye.
• Weakness, numbness, deafness or any other nerve-related symptom.

© EMIS and PIP 2005   Updated: September 2005   PRODIGY Validated

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest.

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