Polymyalgia Rheumatica & Giant Cell Arteritis

Polymyalgia rheumatica is a disorder that causes muscle pain and stiffness in your neck, shoulders, and hips. It is most common in women and almost always occurs in people over 50. In some cases, polymyalgia rheumatica develops overnight. In others, it is gradual. It is an inflammatory disorder.

polymyalgia rheumatica
[pol-ee-mahy-al-jee-uh roomat-i-kuh, –al-juh]
– Noun
a chronic inflammatory disease, common among older persons,
characterized by recurrent episodes of muscle pain and stiffness,
sometimes leading to cardiovascular complications or blindness.

One of my best friends has just been diagnosed with polymyalgia rheumatica and is being tested for giant cell arteritis. It has been a devastating blow, she already has fibromyalgia and was just recently diagnosed with diabetes. Doctors often prescribe prednisone, a steroid medicine. Prednisone will increase her blood sugar, making her diabetes near unmanageable. It will cause her to gain weight and disrupt her sleep patterns. Prayers are welcomed.

She is being tested for giant cell arteritis too. Find an article about it at the bottom of this page.

Symptoms include stiffness in at least two of the following areas::

  • Buttocks
  • Hips
  • Neck
  • Thighs
  • Upper arms and shoulders

Other symptoms of PMR include:

  • Fatigue
  • Fever
  • Poor appetite
  • Weight loss

There is no single test for diagnosis. The doctor goes by your medical history, symptoms, and a physical exam to make the diagnosis. Lab tests for inflammation may help confirm the diagnosis. Blood tests will be done to check inflammation levels and to rule out conditions that cause symptoms similar to PMR, such as rheumatoid arthritis and lupus.

Blood tests may include:

  • Anticyclic citrullinated peptide (anti-CCP)
  • Antinuclear antibody (ANA)
  • Complete blood count (CBC)
  • C-reactive protein (CRP)
  • Erythrocyte sedimentation rate (ESR, also called sed rate)
  • Rheumatoid factor (RF)

The cause of PMR is uncertain but it is believed to be an autoimmune disease in which the body’s own immune system attacks the connective tissues. Genetic and environmental factors (such as infections) are thought to play important roles. Because it is rare in people under age 50, its cause could be linked to the aging process.

Polymyalgia rheumatica usually resolves within 1 to several years. The symptoms of polymyalgia rheumatica are quickly controlled by treatment with corticosteroids, but symptoms return if treatment is stopped too early. Corticosteroid treatment does not appear to influence the length of the disease.

Polymyalgia rheumatica sometimes occurs along with giant cell arteritis, a condition that causes swelling of the arteries in your head. Symptoms include headaches and blurred vision. Doctors often prescribe prednisone, a steroid medicine, for both conditions.

Giant Cell Arteritis

[ahr-tuhrahy-tis] – noun
inflammation of an artery.

Early symptoms of giant cell arteritis may resemble flu symptoms such as fatigue, loss of appetite and fever. Symptoms specifically related to the inflamed arteries of the head include:

  • Headaches
    The pain, which may be mild or severe, tends to be located over the temples but may be in the front or back of the skull.
  • Tenderness of the scalp or temples
  • Double vision
  • Temporary or sustained vision loss (like having a curtain pulled partly over the eye) Up to 20 percent of people with GCA can develop partial or complete blindness. Changes in vision may be a first sign of GCA. Vision loss usually begins suddenly, with difficulty seeing out of one eye. If untreated, vision in the second eye can also be affected. It is rare, however, to become completely blind in both eyes.
  • Dizziness or problems with coordination and balance
  • Jaw pain (claudication)
    Nearly one-half of people with GCA suffer from jaw pain, which develops while chewing food. This is also called jaw claudication. Claudication develops because of inadequate blood flow to the muscles involved in chewing.
  • Upper respiratory complaints
    About 10 percent of people with GCA develop a dry cough or a sore throat
  • Occasional chest pain
  • Arm claudication
    Arm claudication causes pain in the arm, especially when moving the arm. It can develop when the arteries to the arm are narrowed.
  • Thoracic aortic aneurysms
    A thoracic aortic aneurysm occurs when the aorta, the main artery that carries blood from the heart, develops a weak spot and balloons outward. Aneurysms do not cause symptoms but can be life-threatening if they burst. While uncommon, this occurs somewhat more frequently in patients with GCA. People with GCA can be tested for this type of aneurysm with a once-yearly chest radiograph, with echocardiography, or sometimes with other imaging techniques.

Polymyalgia rheumatica and temporal arteritis (giant cell arteritis) are inflammatory disorders that occur in persons older than 50 years. Elderly white women of European ancestry are most commonly affected. The disorders are considered to be closely related conditions in a spectrum of disease affecting the same patient population. The two entities may occur independently or concomitantly in the same patient.

It is unclear how or why polymyalgia rheumatica and giant cell arteritis (temporal arteritis) frequently occur together. But some people with polymyalgia rheumatica also develop giant cell arteritis either simultaneously, or after the musculoskeletal symptoms have disappeared. Other people with giant cell arteritis also have polymyalgia rheumatica at some time while the arteries are inflamed.

When undiagnosed or untreated, giant cell arteritis can cause potentially serious problems, including permanent vision loss and stroke. So regardless of why giant cell arteritis might occur along with polymyalgia rheumatica, it is important that doctors look for symptoms of the arteritis in anyone diagnosed with polymyalgia rheumatica.

Patients, too, must learn and watch for symptoms of giant cell arteritis, because early detection and proper treatment are key to preventing complications. Any symptoms should be reported to your doctor immediately.

CorticosteroidsPrednisone  – Glucocorticoid

Whether taken on a long-term basis for polymyalgia rheumatica or for a shorter period for giant cell arteritis, corticosteroids carry a risk of side effects. Although long-term use and/or higher doses carry the greatest risk, people taking the drug at any dose or for any length of time should be aware of the potential side effects, which include:

  • fluid retention and weight gain
  • rounding of the face
  • delayed wound healing
  • bruising easily
  • diabetes
  • myopathy (muscle wasting)
  • glaucoma
  • increased blood pressure
  • decreased calcium absorption in the bones, which can lead to osteoporosis
  • irritation of the stomach
  • increase in infections.

People taking corticosteroids may have some side effects or none at all. Anyone who experiences side effects should report them to his or her doctor. When the medication is stopped, the side effects disappear. Because corticosteroid drugs reduce the body’s natural production of corticosteroid hormones, which are necessary for the body to function properly, it is important not to stop taking the medication unless instructed by a doctor to do so. The patient and doctor must work together to gradually reduce the medication.

LONG-TERM OUTLOOK

Polymyalgia rheumatica — In most people, polymyalgia rheumatica (PMR) tends to run its course over one to several years, and glucocorticoid therapy can eventually be stopped. In some patients, the disease can persist.

Giant cell arteritis — Giant cell arteritis (GCA) also tends to run its course over one to several years, though occasionally headache and other symptoms can reappear during the first few months after it has been diagnosed. But it is important to remember that if vision is intact when GCA is diagnosed, and if higher-dose, daily glucocorticoid treatment is started immediately, the risk of future vision loss is very small. The dose of glucocorticoids can eventually be reduced and then stopped in many if not most patients.

More information on research is available from the following resources:

  • National Institutes of Health (NIH) Clinical Research Trials and You was designed to help people learn more about clinical trials, why they matter, and how to participate. Visitors to the website will find information about the basics of participating in a clinical trial, first-hand stories from clinical trial volunteers, explanations from researchers, and links on how to search for a trial or enroll in a research-matching program.
  • ClinicalTrials.gov offers up-to-date information for locating federally and privately supported clinical trials for a wide range of diseases and conditions.
  • NIH RePORTER is an electronic tool that allows users to search a repository of both intramural and extramural NIH-funded research projects from the past 25 years and access publications (since 1985) and patents resulting from NIH funding.
  • PubMed is a free service of the U.S. National Library of Medicine that lets you search millions of journal citations and abstracts in the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and preclinical sciences.

Below are the resource I used to write this article:

https://medlineplus.gov/polymyalgiarheumatica.html
https://www.niams.nih.gov/health_info/Polymyalgia/
http://www.arthritis.org/about-arthritis/types/polymyalgia-rheumatica/
http://www.aafp.org/afp/2000/0815/p789.html
http://www.uptodate.com/contents/polymyalgia-rheumatica-and-giant-cell-temporal-arteritis-beyond-the-basics

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  1. Pingback: Medical Pages Added | Invisible Illnesses

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