Polymyalgia Rheumatica

Conditions Basics

What is polymyalgia rheumatica (PMR)?

Polymyalgia rheumatica (say "pah-lee-my-AL-juh roo-MAT-ih-kuh"), or PMR, is a condition that causes inflammation of the joints. This causes pain and stiffness, most often in the neck, shoulders, or hips.

Some people who have PMR also have giant cell arteritis. This is another inflammatory condition that affects the arteries that carry blood to the head. Giant cell arteritis is more dangerous than PMR, though. It can cause loss of vision, a stroke, or mini-strokes. The same medicines are used to treat PMR and giant cell arteritis.

What causes it?

Experts don't fully understand what causes PMR. It may be that the immune system is attacking the body's own tissues. Your genes may play a role in this. For example, people whose ancestors came from Scandinavia or Northern Europe are more likely to have this problem.

PMR occurs in women more often than in men. It is more common as people get older.

What are the symptoms?

Symptoms often start suddenly and get worse without treatment. The most common symptoms are muscle pain and stiffness in the neck, shoulders, or hips. These symptoms are worse in the morning. And they affect both sides of the body–for example, both shoulders, not just one.

Other symptoms may include:

• Tiredness and lack of energy.
• Fever.
• Weight loss.
• Swelling in the knees, wrists, or ankles.

How is it diagnosed?

Your doctor will do a physical exam and ask you about your symptoms and past health. For example, the doctor may look for pain and stiffness in your shoulders, which may be a sign of PMR.

The doctor will also consider your age in diagnosing this condition. People younger than 50 very rarely have PMR.

Your doctor may order tests too. These may include:

• Blood tests such as sedimentation rate and C-reactive protein. These tests can show if you have inflammation in your body.
• Complete blood count. This test can show if you have anemia, which is common in people who have PMR.

Some other conditions can cause similar symptoms. Your doctor may also do tests to rule out those conditions, which include arthritis and hypothyroidism.

How is PMR treated?

PMR is treated with steroid medicines, which reduce inflammation. You'll probably feel better in a day or two after you start the medicine. Most of the time, symptoms improve quickly and go away 2 to 4 weeks after treatment begins. But you may need to keep taking steroid medicine for 1 to 2 years or even longer. This helps to keep your symptoms from coming back.

In some people, symptoms improve with treatment but then come back. This is called a relapse. It often occurs in the first 2 years of treatment or during the first year after steroid medicine is stopped. Your doctor will track your condition during this time. If you have a relapse, your doctor will increase your steroid dosage for a while. Then you can slowly lower it after your symptoms go away.

Long-term treatment with steroid medicine will put you at risk for bone thinning (osteoporosis). This is because steroid medicines reduce how well your body takes in calcium, which is important in building strong bones. Your doctor may recommend a bone density test to see if you need medicine to prevent osteoporosis. These medicines are called bisphosphonates. Or your doctor may start you on the medicine without the test.

Your doctor may also suggest that you take medicine to help protect your digestive tract, such as a proton pump inhibitor or an H2 blocker. Taking medicines like steroids for a long time can irritate your esophagus and stomach and lead to ulcers. Proton pump inhibitors and H2 blockers help reduce this irritation.

How can you care for yourself during treatment?

To protect your bones while you are being treated with steroid medicines:

• Be sure you get enough calcium and vitamin D. Calcium can help prevent bone thinning. Vitamin D helps your body absorb calcium.
• Ask your doctor if you need to take calcium and vitamin D supplements. Calcium supplements may interfere with your body's ability to absorb biophosphonates. So take your calcium and vitamin D supplement at least 30 minutes after you take your bisphosphonate.
• Get regular weight-bearing exercise, such as walking, dancing, or weight lifting. This will help keep your bones strong and may also help your mood.
• Don't smoke, and avoid being around tobacco smoke.
• Limit alcohol. It's a good idea to have no more than one beer or one glass of wine each day.