Polymyalgia Rheumatica: Causes, Risk Factors, Symptoms, Diagnosis, Treatment and Management

This condition usually affects the neck and shoulder area as well as the hip area.

Polymyalgia rheumatica is an inflammatory disease that causes stiffness and pain.

The term “Myalgia” comes from the Greek word for “muscle pain” and poly means many.

The pain and stiffness typical of polymyalgia present with greater intensity in the morning hours.

For some patients, polymyalgia rheumatica can appear suddenly. For others, its development can be gradual over several days or weeks.

One characteristic of polymyalgia rheumatica is that it only affects the elderly. Polymyalgia rheumatica occurs most often after age 50.

It is a geriatric ailment because it becomes common over the years.

It has been observed that it has a greater incidence in females than in males, and it seems to have some common factor in families.

Polymyalgia rheumatica is a disease that is classified as chronic and commonly affects the large joints and periarticular structures.

After rheumatoid arthritis , polymyalgia rheumatica is the second most common autoimmune rheumatic disease, with a lifetime risk of approximately 2%.

Polymyalgia rheumatica tends to be confused with fibromyalgia , a little-known syndrome, which is why its diagnosis is often difficult.

Causes of polymyalgia rheumatica

Researchers are still doing research to know for sure the causes of polymyalgia rheumatica. Because it can happen quickly, which is why some think it is caused by an infection.

Polymyalgia rheumatica can affect blood members of some families, which is believed to be due to genetic factors.

Although the etiology and pathogenesis of polymyalgia rheumatica are not known, epidemiological studies suggest that there are environmental factors involved in the development of this disease.

This is further evidenced by a geographic variation in the incidence of polymyalgia rheumatica, with the highest rates observed among the inhabitants and descendants of northern European countries.

Although polymyalgia rheumatica has been observed in people of Hispanic, Asian, and African heritage, incidence rates among these ethnicities are notably lower.

Specific tests of the muscles, such as a blood test for muscle enzymes or a muscle biopsy (surgical removal of a small piece of muscle for inspection under a microscope), are all normal in clinical cases of polymyalgia rheumatica.

Risk factors for polymyalgia rheumatica

Some factors seem to increase the risk of polymyalgia rheumatica, such as:

  • Advanced age (age greater than or equal to 50 years).
  • Being Caucasian, especially of Scandinavian descent.
  • Be female.

Symptoms of polymyalgia rheumatica

The characteristic symptoms of polymyalgia rheumatica are pain and stiffness in the shoulders, neck, and hips.

The most recent research has suggested that the pains that occur in polymyalgia rheumatica that involve the shoulder and hip joints, also present inflammation in the bags (or sacs) that surround these joints.

In this way, the pain that occurs in the upper arms and thighs, begins in the joints of the shoulders and hips closest to the area of ​​pain and this is what is known in medicine as «referred pain ».

In polymyalgia rheumatica, pain and stiffness are generalized and both sides of the body are always equally affected.

Involving the upper arms, with trouble raising them above the shoulders, is very common.

The pain sometimes even occurs in the joints, hands and wrists.

The discomfort is always greatest in the morning and improves as the day goes on.

It is observed that when the person is subjected to prolonged periods of inactivity, such as long car trips or when a person remains seated for a long period of time in the same position, stiffness can manifest itself.

Periods of stiffness can even be so severe that it may cause any of these consequences:

  • Problems with sleep can occur, the discomfort can disturb the patient in such a way that it can present problems sleeping at night.
  • They may have trouble getting dressed in the morning. You may have trouble raising your arms above shoulder level. This can make dressing difficult. or bend over to put on socks and shoes. You may have trouble rolling over in bed when you get up in the morning.
  • They may have trouble getting up when sitting or getting in and out of a car

Other symptoms that may occur are:

  • Swelling in the hands, wrists, feet, and ankles.
  • Tingling sensation, numbness and pain in the hands, wrists, or even the forearm.
  • Feeling of weakness
  • General malaise.
  • Feeling tired.
  • Loss of appetite and therefore weight loss.
  • Low fever

Some people with polymyalgia rheumatica may also have a condition called giant cell arteritis . Also called temporal arteritis, Horton’s arteritis. This is an inflammation of the blood vessels in the head, neck, and arms.

This inflammation can narrow or block blood vessels, which can cause problems with less blood flow through them.

Giant cell arteritis can cause symptoms such as:

  • Headaches.
  • Changes in vision
  • Jaw pain, especially when chewing.
  • Scalp pain.
  • Ulcers on the scalp.
  • High fevers

Diagnosis of polymyalgia rheumatica

Laboratory parameters in polymyalgia rheumatica are not specific, but generally show evidence of a systemic inflammatory state.

These abnormalities may include mild normocytic anemia due to chronic inflammation, leukocytosis, and thrombocytosis.

Inflammatory markers (erythrocyte sedimentation rate and C-reactive protein) are often elevated.

The erythrocyte sedimentation rate, however, can be normal in 6% to 20% of patients with polymyalgia rheumatica. Therefore, C-reactive protein may be a more sensitive marker of inflammation in these patients.

Rheumatoid factor and antitrullinated protein antibodies are generally absent, and their presence should raise suspicion for rheumatoid arthritis.

Additional laboratory studies that are useful in differential diagnosis include liver transaminases, creatine kinase, calcium, sodium, potassium, magnesium, creatinine, thyroid stimulating hormone, serum protein electrophoresis, and microscopic urinalysis.

In recent years, there has been an increased use of imaging modalities to evaluate patients with suspected polymyalgia rheumatica.

Ultrasound and MRI have commonly identified abnormalities in large joints and periarticular structures.

Characteristic findings in patients with polymyalgia rheumatica may include bicipital tenosynovitis, subacromial and subdeltoid bursitis.

Treatment of polymyalgia rheumatica

Steroid medication is the main treatment for polymyalgia rheumatica.

The doctor will recommend a low dose of this medicine and when the symptoms improve, the doctor will slowly reduce the amount of medicine. If the symptoms return, the dose will be increased.

You may need to take a steroid for a few years. Return of symptoms is common, so steroid medications may need to be resumed in the future.

Polymyalgia rheumatica often responds quickly to steroid medications. This can help confirm that the patient has polymyalgia rheumatica.

If the symptoms do not disappear after two to three weeks of treatment, the diagnosis of polymyalgia rheumatica is unlikely and the doctor will consider other causes of the disease and the patient may be referred to a rheumatologist for diagnosis.

Daily exercise and physical rest play an important role in the treatment of polymyalgia rheumatica.

Regular exercise is essential for maintaining strength, function, and flexibility in your joints and muscles.

Ideal forms of exercise include walking, riding a stationary bike, and swimming in a pool. Rest is also important for the body to recover from exercise and other daily activities.

Management of polymyalgia rheumatica

The symptoms of polymyalgia rheumatica improve with treatment. Once this begins, the patient can return to normal activities.

Your doctor will monitor your symptoms and adjust steroid doses until you can respond to the condition with the lower doses. Small changes in steroid doses can have a big effect on symptoms.