What Is Polymyalgia Rheumatica?
Polymyalgia rheumatica (PMR) is an inflammatory condition affecting the muscles in and around the shoulder and upper arm areas, buttocks and thighs. The cause is unknown.
Polymyalgia rheumatica usually starts very suddenly. The stiffness in affected areas usually eases as the day progresses, but often returns in the evenings. In contrast to rheumatoid arthritis the joints are not usually involved, though occasionally there can be an associated inflammation in joints such as the shoulder, hip and wrist. Very occasionally, the arteries supplying the head and neck area of the body may be involved, causing headaches and possible loss of sight. This very serious complication of the disorder requires immediate treatment.
What are the symptoms of polymyalgia rheumatica (PMR)?
Severe and painful stiffness in the morning is one of the most common symptoms of polymyalgia rheumatica (PMR), particularly in your shoulders and thighs. PMR can come on suddenly, appearing within a fortnight and sometimes just after a flu.
It is unlike the sort of pain or stiffness you experience after exercising. Instead it is often widespread and made worse by movement. It can also disrupt your sleep at night.
How is polymyalgia rheumatica (PMR) diagnosed?
There is no specific test to diagnose polymyalgia rheumatica. Based on your symptoms, tests and a physical examination your doctor will make the diagnosis.
Inflammation alone isn’t enough to confirm the diagnosis as it’s associated with many other conditions. Other conditions, such as rheumatoid arthritis, will need to be ruled out with some other tests. X-rays or ultrasound scans of your shoulders and hips may also be necessary.
What treatments are there for polymyagia rheumatica (PMR)?
Steroid tablets are the most common treatment for polymyalgia rheumatica (PMR). They are not a cure but they can reduce your symptoms symptoms within a day or 2 once you start treatment. Your treatment will probably last for 2 years or more depending on your symptoms.
Your doctor may suggest you also take the following:
- bisphosphonates such as risedronate or alendronate to protect you against developing osteoporosis
- painkillers or non-steroidal anti-inflammatory drugs (NSAIDs) to reduce your pain and stiffness
If you are finding that your symptoms are not improving with steroids, you may be sent by your doctor to see a specialist who may prescribe methotrexate tablets alongside the steroid tablets. Methotrexate is used to treat several different types of rheumatic disease including polymyalgia rheumatica. Because one of its actions is to reduce the activity of the immune system, it can leave you prone to infection and it is important to tell your doctor immediately if you develop a sore throat, fever, bruising or bleeding or any other new symptoms
It’s important to have regular check-ups and blood tests when you’re taking methotrexate so its effects can be monitored. It can cause side-effects, such as feeling sick or mouth ulcers.
More rarely it can cause more serious side-effects in the blood, liver or lungs. Most of these are picked up by the regular blood tests and get better if the drug is stopped.
Methotrexate is usually only given to people whose symptoms keep coming back. As the methotrexate takes effect it’s usually possible to reduce the dose of prednisolone.