Polymyalgia Rheumatica: Symptoms, Causes, and Prognosis

Polymyalgia rheumatica is a condition in which inflammation affects the muscles around the shoulders, neck, and hips. It most often occurs in people over 50, and recognizing it can be difficult: the picture resembles other joint diseases. Below is what is known about the symptoms, possible causes, and prognosis.

What is polymyalgia rheumatica

This is an inflammatory disease that manifests as pain, stiffness, and inflammation in the muscles around the shoulders, neck, and hips. The disease almost always occurs in people over 50 and more often in women. Polymyalgia is associated with giant cell arteritis — it is probably a low-symptom form of this arteritis. The incidence is estimated at approximately 20 cases per 100,000 population over 50, and the typical age of patients is 70–80 years.

Main symptoms of polymyalgia

The main sign is morning stiffness in the muscles that lasts longer than 45 minutes. Other possible manifestations: severe fatigue, loss of appetite, weight loss, low mood. Fever and weakness also occur. The pain is usually symmetrical, sometimes very severe, and begins gradually — over several days, less often weeks; lower back pain is possible. In some people the condition develops literally overnight, in others it builds up slowly.

Possible causes and risk factors

The cause of polymyalgia is unknown. A combination of genetic and external factors is suspected. The disease is associated with age: most of those affected are people over 65, and in those younger than 50 it occurs very rarely. Women are affected more often than men. An association is noted with the HLA system and cytokine systems IL12/IFNgamma, as well as IL6, IL17, IL21.

How polymyalgia rheumatica is diagnosed

There is no specific test. The doctor relies on the medical history, complaints, and examination, and laboratory tests for inflammation help confirm the diagnosis. Erythrocyte sedimentation rate (ESR) is used — usually above 50 mm/hour, C-reactive protein (elevated), IL6. To distinguish it from other diseases, rheumatoid factor, ANCA, ACPA are checked (they should be negative), along with blood picture, glucose, creatinine, alkaline phosphatase, calcium, vitamin D. If giant cell arteritis is suspected, magnetic resonance vascular imaging (magnetic scanning with angiography) or FDG-PET/CT is used.

• Morning stiffness lasting longer than 45 minutes
• Symmetrical pain in the shoulders, neck, hips
• Fatigue, loss of appetite, weight loss
• Elevated ESR and C-reactive protein

Prognosis and possible complications

Without treatment, the condition usually resolves within a year or more. Life expectancy is not reduced unless a severe form of arteritis develops. Up to 1 in 5 people with polymyalgia develop giant cell arteritis — inflammation of the arteries of the head and neck, which without prompt treatment can lead to stroke or blindness.

Polymyalgia itself is not a reason to call an ambulance. Call 103 or 112 if sudden new or frequent headache appears (the scalp is tender), pain in the jaw muscles or tongue when eating and talking, double vision or loss of vision in one or both eyes — these are signs of giant cell arteritis.

When to see a doctor

If pain and stiffness persist for more than a week, the doctor should determine the cause. Diagnosis is difficult because the picture resembles many other conditions, including rheumatoid arthritis, and these must be ruled out. With the eye and jaw symptoms mentioned above, seek help immediately. Ask your doctor: what inflammation tests will be done for me, how will rheumatoid arthritis be ruled out, how will arteritis be checked, how often should ESR and C-reactive protein be monitored. This material is for reference and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer