Polymyalgia rheumatica guide

What is polymyalgia rheumatica syndrome?

Polymyalgia rheumatica is an inflammatory condition that affects the muscles in the neck, shoulders and hips. The pain and stiffness can be incredibly debilitating and is generally worse in the morning.

So stiff you can hardly get out of bed? You might have PMR

PMR is simply an abbreviated term for polymyalgia rheumatica, used by medical professionals.

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Unfortunately, the causes of polymyalgia rheumatica are still unknown.

The condition is relatively common among the over-50s, and older women are at least two to three times as likely to get polymyalgia than older men. It is also much more prevalent among white Europeans, which suggests a genetic link – although this is yet to be proven.

Bilateral shoulder pain – pain in both shoulders – is a key symptom of polymyalgia.

Other symptoms include: stiffness and severe pain in the morning, which gradually eases throughout the day; pain in the neck, hips, thighs or back; stiffness after sitting for any length of time; swelling of the hands or wrists; fatigue; low mood; and generally feeling unwell with a slight temperature.

These symptoms can come on suddenly, sometimes after a flu-like illness. In some people, however, they creep up gradually over a longer period of time.

The good news is that most people with polymyalgia will see their symptoms completely disappear after one or two years. However, a few will need to continue on a small dose of medication for longer.

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Your doctor is likely to prescribe corticosteroids to reduce the pain of polymyalgia. Sometimes called 'steroids' for short, these drugs work by reducing inflammation – and even a small dose can be hugely effective at easing pain and stiffness.

Disease-modifying anti-rheumatic drugs (DMARDs) may be used in rare cases when polymyalgia rheumatica flare-ups can't be controlled by corticosteroids. DMARDs, which include methotrexate and leflunomide, work by treating the causes of inflammation. They should be prescribed as early as possible if the condition is severe.

Corticosteroids are extremely effective at treating polymyalgia rheumatica, but can have many side effects. So it's important to stick to the prescribed dose, and to discuss any concerns you may have with your doctor. You will most likely be started on a moderate dose that's then gradually reduced until you're on the lowest possible effective dose to control the condition. Known as a maintenance dose, this can take a little while to get right.

You should be given a steroid card to carry with you at all times, so other health professionals know what you're taking. It is dangerous to stop taking steroids suddenly.

The longer you take corticosteroids, and the higher the dose, the greater your risk of side effects. These can include weight gain, bruising easily, a round face, stretch marks, thinning skin, cataracts and a rise in your blood sugar level (which may affect your medication needs if you have diabetes), high blood pressure, osteoporosis and becoming more prone to infections. Tell your doctor immediately if you come into contact with anyone suffering from shingles or chickenpox, as you may need urgent preventative treatment.

What is giant cell arteritis?

Around one to two people in 10 with polymyalgia rheumatica also develop a condition called temporal arteritis – or giant cell arteritis. This is when blood vessels become inflamed, cutting off the blood supply to certain areas of the body. The arteries in the temples are the most commonly affected area.

Possible symptoms of giant cell arteritis include vision loss, blurred vision, double vision or seeing a shadow over your vision. You may also suffer from severe headaches, jaw and tongue pain, and tenderness of the scalp.

If you experience any of the above, contact your doctor immediately. If caught early enough, giant cell arteritis can be successfully treated with corticosteroids. If your doctor suspects you may have the condition, you might need to have an ultrasound scan of the arteries in your temples and/or a biopsy of the blood vessel in your scalp.

If you have any of the symptoms of polymyalgia rheumatica or giant cell arteritis, contact your GP immediately. Because both share similarities with other conditions, they can be difficult to diagnose so it's important to provide as much detail as possible.

Your doctor may want to carry out a blood test for polymyalgia, such as erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). These tests measure the amount of inflammation in the body, but don't necessarily mean a polymyalgia rheumatic diagnosis is correct.

You may be referred to a rheumatologist to confirm the diagnosis and advise on treatment. During this process, you may require an ultrasound scan of the shoulders and hips. If you are diagnosed with giant cell arteritis, you are also likely to see an eye specialist, known as an ophthalmologist.

Keeping fit and active can help relieve the muscle pain and stiffness of polymyalgia rheumatica, and reduce risk of the bone-thinning disease osteoporosis. Weight-bearing activities, such as brisk walking, are key to bone health.

Eating a healthy, balanced diet with plenty of fresh fruit and vegetables is important, too.

Finally, staying informed about polymyalgia rheumatica is the best way to manage the condition effectively. Learn to listen to your body, adjust your activities accordingly – and consult your doctor as soon as possible if symptoms worsen.

For more information on polymyalgia rheumatica, go to www.arthritiscare.org.uk and download your free factsheet.

For facts, support and guidance on all aspects of arthritis, call Arthritis Care’s free Helpline on 0808 800 4050. It's open Monday to Friday, 09:30-17:00. 

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