Polymyalgia is a form of arthritis that causes pain in the muscles of the lower back, thighs, hips, neck, shoulder and upper arms, as well as in other parts of the body. The word comes from the Greek poly (many), myo (muscle) and algia (pain). It happens when the membrane that surrounds joints, bursa and tendons near the shoulders and hips (called the synovium) becomes inflamed. Although the disease is centered on the joints (especially the shoulders and hips), the discomfort is felt in the upper arms and thighs. This type of pain is called referred pain because it arises in one area but causes symptoms in another.

Typically, polymyalgia rheumatica affects people older than 55, with slightly more women affected than men. Left untreated, it can lead to stiffness and significant disability. In some cases, though, symptoms do not get worse and may even lessen in a few years. In a minority of cases, polymyalgia rheumatica is associated with giant cell arteritis (also called temporal arteritis), a condition in which blood vessels in the neck and head, and sometimes elsewhere, are inflamed. Common symptoms of giant cell arteritis include visual complaints, jaw pain with chewing and headache. If left untreated, giant cell arteritis can lead to blindness or other complications.

Symptoms of polymyalgia rheumatica can include:

• Sudden pain and stiffness in the shoulders, upper arms, neck, lower back, hips and thighs that tends to be worse in the morning
• Low-grade fever
• Joint swelling, for example, in the wrists
• Difficulty walking
• Weight loss
• Fatigue

Your doctor will diagnose this condition based on a physical examination and your description of symptoms. Certain symptoms, such as headache, jaw pain when you chew or high fever, may suggest the presence of giant cell arteritis. A blood test to measure inflammation throughout the body, called the erythrocyte sedimentation rate (ESR), is often elevated in people with polymyalgia rheumatica. This test may be helpful both to diagnose the condition and to check whether treatment is working.

Without treatment, polymyalgia rheumatica sometimes goes away on its own over several years. With treatment, symptoms lessen or go away within days. Treatment is generally necessary for at least six months and often one to two years because symptoms tend to come back if you stop or reduce your treatment.

Because the cause of polymyalgia rheumatica is not known, there is no way to prevent it.

Although nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin and others) or naproxen (Aleve, Naprosyn) often are tried, they are rarely very helpful. Corticosteroids (such as prednisone) usually are required to treat polymyalgia rheumatica effectively. Low doses (10 to 20 milligrams per day) are highly effective.

Physical therapy may help to control discomfort and maintain the ability to move and function. For people who have significant side effects, other drugs such as hydroxychloroquine (Plaquenil) or methotrexate (Rheumatrex, and others) often are prescribed. Doctors may prescribe additional medications to prevent the side effects of prednisone; for example, alendronate (Fosamax) to prevent osteoporosis.

If you have joint or muscle pain that is severe or sudden, especially if it prevents you from participating in your normal activities, contact your doctor for an evaluation. This may be an urgent condition if you have symptoms such as fever, visual problems or headache because these symptoms suggest that you could have giant cell arteritis.

Although treatment may be required for years, the outlook for people with polymyalgia rheumatica is excellent.

If you have giant cell arteritis, you may lose vision in one eye or, more rarely, in both eyes, especially if treatment is delayed.

American College of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345
Phone: 404-633-3777
Fax: 404-633-1870
E-Mail: acr@rheumatology.org
http://www.rheumatology.org/

Arthritis Foundation
P.O. Box 7669
Atlanta, GA 30357-0669
Toll-Free: 1-800-283-7800
http://www.arthritis.org/