The cause is unknown.
The neck, back, shoulders, and hips feel stiff and painful.
The diagnosis typically is based on symptoms and the results of blood tests.
Most people improve dramatically when they take prednisone, a corticosteroid.
(See also Overview of Vasculitis Overview of Vasculitis Vasculitic disorders are caused by inflammation of the blood vessels (vasculitis). Vasculitis can be triggered by certain infections or drugs or can occur for unknown reasons. People may have... read more .)
Polymyalgia rheumatica occurs in people over age 55. Women are affected more often than men. The cause of polymyalgia rheumatica is unknown. Polymyalgia rheumatica may occur before, after, or at the same time as giant cell (temporal) arteritis Giant Cell Arteritis Giant cell arteritis is chronic inflammation of large and medium arteries of the head, neck, and upper body. Typically affected are the temporal arteries, which run through the temples and provide... read more . Some experts think that the two disorders are variations of the same abnormal process. Polymyalgia rheumatica seems to be more common.
Symptoms of Polymyalgia Rheumatica
Symptoms of polymyalgia rheumatica may develop suddenly or gradually. Severe pain and stiffness occur in the neck, shoulders, upper and lower back, and hips. The stiffness and discomfort are worse in the morning and after periods of inactivity and are occasionally severe enough to prevent people from getting out of bed and from doing simple activities. People may feel weak, but the muscles are not damaged or weak. People may also have a fever, feel generally unwell or depressed, and lose weight unintentionally.
Some people with polymyalgia rheumatica also have symptoms of giant cell arteritis Symptoms Giant cell arteritis is chronic inflammation of large and medium arteries of the head, neck, and upper body. Typically affected are the temporal arteries, which run through the temples and provide... read more , which can lead to blindness. Some people have mild arthritis, but if the arthritis is severe or is the main symptom, the diagnosis is more likely to be rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more .
Diagnosis of Polymyalgia Rheumatica
Response to corticosteroids
Doctors base the diagnosis of polymyalgia rheumatica on symptoms and the results of a physical examination. Doctors do other tests, such as blood tests, to distinguish polymyalgia rheumatica from other disorders. Blood tests usually include the following:
Erythrocyte sedimentation rate (ESR), C-reactive protein levels, or both: In people with polymyalgia rheumatica, results of both tests are usually very high, indicating active inflammation.
Complete blood count Complete blood count Doctors select tests to help diagnose blood disorders based on the person's symptoms and the results of the physical examination. Sometimes a blood disorder causes no symptoms but is discovered... read more : This test is done to check for anemia and high platelet count, which usually develops in people with polymyalgia rheumatica.
Thyroid-stimulating hormone Thyroid function tests The thyroid is a small gland, measuring about 2 inches (5 centimeters) across, that lies just under the skin below the Adam’s apple in the neck. The two halves (lobes) of the gland are connected... read more (TSH): This test is done to rule out hypothyroidism, which can cause weakness and sometimes pain of the shoulder and hip muscles.
Creatine kinase: This test is done to check for muscle tissue damage (myopathy), which can cause weakness and pain of the shoulder and hip muscles. If the level of creatine kinase in the blood is elevated, muscle damage is likely. In people with polymyalgia rheumatica, muscle damage is absent, so the creatine kinase level is normal.
Rheumatoid factor and anti-cyclic citrullinated peptide antibodies testing: These antibodies Antibodies One of the body's lines of defense ( immune system) involves white blood cells (leukocytes) that travel through the bloodstream and into tissues, searching for and attacking microorganisms and... read more are present in up to 80% of people with rheumatoid arthritis but not in those with polymyalgia rheumatica. This test helps doctors distinguish between the two.
The diagnosis is also supported by how people respond to corticosteroids because most people with polymyalgia rheumatica feel much better very quickly when treated with low doses of corticosteroids.
Treatment of Polymyalgia Rheumatica
Taking a low dose of prednisone, a corticosteroid, usually causes dramatic improvement in people with polymyalgia rheumatica. If people also have giant cell arteritis Giant Cell Arteritis Giant cell arteritis is chronic inflammation of large and medium arteries of the head, neck, and upper body. Typically affected are the temporal arteries, which run through the temples and provide... read more , a higher dose is prescribed to reduce the risk of blindness. As the symptoms subside, the dose is gradually reduced (tapered) to the lowest effective dose. Many people can stop taking prednisone in about 2 years. However, some people need to take a low dose for several years.
Corticosteroids commonly cause side effects in older people (see ).
Giant cell arteritis Giant Cell Arteritis Giant cell arteritis is chronic inflammation of large and medium arteries of the head, neck, and upper body. Typically affected are the temporal arteries, which run through the temples and provide... read more may develop at the start of polymyalgia rheumatica or much later, sometimes even after people appear cured of the disorder. Therefore, all people should immediately tell their doctor if they have headache, muscle pain during chewing, unusual cramping or fatigue of the arms or legs with exercise, or vision problems.
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
Vasculitis Foundation: Provides information for patients about vasculitis, including how to find a doctor, learn about research studies, and join patient advocacy groups