Polymyalgia Rheumatica

Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness, particularly in the shoulders and hips. The condition develops most often in people ages 65 and older, and it might be related to another inflammatory disorder known as giant cell arteritis.

Diagnosing polymyalgia rheumatica and other rheumatic diseases can be difficult because the diseases share many common symptoms. At UT Southwestern, our rheumatologists (specialists in diseases that affect joints, bones, muscles, and the immune system) have extensive experience in assessing patients to determine the exact cause of their symptoms. 

We take a multidisciplinary team approach to care for people with polymyalgia rheumatica. Working together, we provide personalized treatment to manage the condition and improve our patients’ quality of life.

Causes and Risk Factors of Polymyalgia Rheumatica

Medical experts have not yet found the exact cause of polymyalgia rheumatica, but they have found that two factors are involved:

• Certain genes or gene variations might increase the risk of polymyalgia rheumatica.
  
• Environmental factors, perhaps exposure to a virus, might trigger the disease.
  

Symptoms of Polymyalgia Rheumatica

Generally, symptoms affect both sides of the body and include:

• Pain in the shoulders that can spread to the neck or arms
  
• Pain in the hips that can spread to the buttocks or thighs
  
• Stiffness in affected areas that is worse in the morning or after inactivity
  
• Reduced range of motion in affected areas

Other symptoms can include:

• Fatigue
  
• Feeling of illness or discomfort
  
• Fever
  
• Loss of appetite, which can lead to weight loss

We typically monitor patients with polymyalgia rheumatica regularly because giant cell arteritis occurs in roughly 15 percent of patients with polymyalgia rheumatica. Giant cell arteritis is inflammation in the lining of the arteries that support the eyes, and it causes different symptoms. Rarely – but devastating if untreated – giant cell arteritis can result in stroke or blindness. 

The following symptoms suggest giant cell arteritis and should prompt immediate medical attention.

• Persistent, new, or unusual headaches
  
• Jaw pain or tenderness
  
• Vision loss, or blurred or double vision
  
• Scalp tenderness
  

Diagnosing Polymyalgia Rheumatica

Polymyalgia rheumatica is often mistaken for rheumatoid arthritis because the two conditions have similar symptoms. Our rheumatologists have extensive experience in diagnosing and treating diseases that affect joints, bones, muscles, and the immune system, and we conduct a comprehensive evaluation that includes:

• Discussion of symptoms
• Discussion of personal and family medical history
• Physical exam, especially of the joints
• Appropriate laboratory and diagnostic testing 

To confirm a diagnosis of polymyalgia rheumatica, our doctors might recommend one or more tests, such as:

• Blood test to look for signs of inflammation, the body’s natural response to illness or injury, such as high levels of C-reactive protein or an elevated erythrocyte sedimentation rate
  
• Magnetic resonance imaging (MRI) scan of joints to look for other causes of shoulder and hip pain
  
• Ultrasound to distinguish between polymyalgia rheumatica and other conditions with similar symptoms
  

Treatment for Polymyalgia Rheumatica

Polymyalgia rheumatica requires treatment with medications to relieve symptoms and manage the condition. 

At UT Southwestern, medications we typically prescribe for polymyalgia rheumatica include:

• Low-dose corticosteroids taken as pills to relieve pain and stiffness
  
• Supplements of calcium and vitamin D to help prevent bone loss that can result from long-term corticosteroid treatment; patients on long-term steroids might require bone density testing and further treatment for bone thinning

Medications might need to be taken over a long period of time to help reduce the risk of relapse.