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Arthritis: Polymyalgia Rheumatica and Temporal Arteritis

Polymyalgia rheumatica is a rare, inflammatory condition that causes pain or aching in the large
muscle groups, especially around the shoulders and hips. Polymyalgia literally means "many
muscle pains." Rheumatica means "changing" or "in flux."
What Are the Symptoms of Polymyalgia Rheumatica?
Symptoms tend to develop quickly and in addition to muscle pain, other symptoms may include
the following:

Stiffness, especially in the morning and after resting


Weakness
Fatigue
Generally feeling ill
Mild fevers (occasionally)
Weight loss
What Is Temporal Arteritis?
About 15% of people with polymyalgia rheumatica also have temporal arteritis and about half of
people with temporal arteritis also have polymyalgia rheumatica. Temporal arteritis causes
inflammation that damages large and medium-sized arteries. The name of the condition stems
from the fact that some of the affected arteries provide blood to the head, including the temples.
Temporal arteritis is also known as "giant cell arteritis."
What Are the Symptoms of Temporal Arteritis?
Temporal arteritis has several symptoms, including:

Severe headaches are the most common symptom.


Scalp tenderness.
Jaw or facial soreness, especially with chewing.
Vision changes or distorted vision caused by decreased blood flow.
Stroke may occur in less than 5% of patients and is caused by decreased blood flow.
The large blood vessels may become narrowed or enlarged (aneurysm). If narrowing
occurs in the blood vessels leading to the arms or legs, patients may notice fatigue or aching in
the limbs, due to a reduced blood supply. Your doctor may notice weak or absent pulses.
Other symptoms may include fever, weight loss, night sweats, depression, fatigue and a
general feeling of being ill.
Who Is Affected By Polymyalgia Rheumatica and Temporal Arteritis?
Polymyalgia rheumatica and temporal arteritis frequently affect the same types of people. People
over 50 years old are most often affected. The average age of patients is 70. These diseases are
more common among women, and Caucasians are more likely to get these diseases than other
ethnic groups.
The exact cause of these illnesses is unknown.
How Are Polymyalgia Rheumatica and Temporal Arteritis Diagnosed?
If a doctor suspects polymyalgia rheumatica after hearing a patient's symptoms and the
examination, then blood tests will likely be done to help confirm the diagnosis. The blood tests will
help test for inflammation as well as help rule out other possible causes of the symptoms, such as
rheumatoid arthritis or an underactive thyroid.
Everyone with polymyalgia rheumatica is also tested for temporal arteritis. This, too, would start
with the examination and listening to the patient's symptoms.

If temporal arteritis is suspected, but less convincing features are present, a temporal artery
biopsy may confirm the diagnosis. The biopsy is taken from a part of the artery located in the
hairline, in front of the ear. In most cases the biopsy is helpful, but in some individuals it may be
negative or normal, even though the person does have temporal arteritis.
Can Other Problems Be Confused With Polymyalgia Rheumatica?
Yes. Some other illnesses that may be confused with polymyalgia rheumatica include:

Rheumatoid arthritis
Infections
Inflammation of blood vessels ( vasculitis)
Chemical and hormone abnormalities
A variety of muscle diseases
Cancer
How Are Polymyalgia Rheumatica and Temporal Arteritis Treated?
There is no known cure for polymyalgia rheumatica and temporal arteritis, but these diseases can
be treated and controlled. Corticosteroids -- often called "steroids" -- help rapidly relieve the
symptoms of both polymyalgia rheumatica and temporal arteritis.
Treatment with steroids -- usually in the form of prednisone -- is mandatory for temporal arteritis
to prevent serious complications, such as blindness. Low doses of steroids are often successful
in treating polymyalgia rheumatica. Higher doses are often required to treat temporal arteritis.
The excellent response to treatment is so uniform that the lack of dramatic improvement, within
days, would make the diagnosis of temporal arteritis or polymyalgia rheumatica doubtful.
Steroids reduce the function of inflammatory cells that cause these illnesses. Consequently,
steroids minimize tissue damage. Steroids also reduce the normal activity of the immune system
-- thus increasing the risk of infection.
The decision to prescribe steroids is always made on an individual basis. Your doctor will
consider your age, presence of other illnesses and medications you are taking. Your doctor also
will make sure you understand the potential benefits and risks of steroids before you start taking
them.
You will have frequent blood tests while taking steroids to monitor possible side effects and to
evaluate the effectiveness of therapy. These blood tests can usually detect problems before you
are aware of any symptoms. Your doctor will frequently evaluate your heart and lung function and
blood sugar level, which may increase after you start taking steroids.
While taking steroids, it is important to keep all appointments with your doctor and the laboratory,
and have your blood pressure checked regularly.
Because steroids increase your chance for developing infections, report symptoms such as a
cough, fever or shortness of breath to your doctor.
Long-term steroid treatment (for a few months to several years) requires additional testing and
monitoring. Long term use of steroids can cause osteoporosis (bone loss). Taking supplements of
calcium and vitamin D, sometimes along with prescription medication is recommended to prevent
osteoporosis. Discuss the potential side effects caused by long-term steroid therapy with your
doctor.

What Is the Long-term Outlook?


With careful monitoring and appropriate treatment, most patients with polymyalgia rheumatica or
temporal arteritis have a normal life span and lifestyle. The success of treatment is related to
prompt diagnosis, aggressive treatment and careful follow-up to prevent or minimize side effects
from the medications.

What is polymyalgia rheumatica?

Polymyalgia rheumatica (pronounced pah-lee-my-al-jah room-at-i-ca) is a type of arthritis


that affects the muscles. It does not affect the bones, or the joints, which are the spots
where two bones come together.
It causes muscles to become stiff, tender and very sore. This is called inflammation.
Even though the muscles are sore they do not become weak.
Polymyalgia rheumatica affects the muscles of the neck, shoulders, lower back, hips and
thighs.
It is believed that the pain is caused by the swelling of blood vessels in the muscles.
Giant cell arteritis is a condition related to polymyalgia rheumatica. It causes the blood
vessel on the front of the head to swell. It can cause a person to go blind.

Polymyalgia rheumatica is a syndrome characterized by severe pain and stiffness in the muscles
of the neck, shoulder girdles, low back, hips and thighs. There is no corresponding weakness of
the muscles.
It is thought that polymyalgia rheumatica is a result of blood vessels becoming inflamed.
The name polymyalgia rheumatica actually comes from Greek words. In Greek, 'poly' means
'many,' 'my' means 'muscle,' and 'algia' means 'pain' (many muscle pain) and 'rheumatica' refers
to 'muscle and soft tissue.'
A condition associated with polymyalgia rheumatica is called giant cell arteritis. It sometimes
occurs in people who have polymyalgia rheumatica. It causes the arteries on the upper front side
of the head, called the temporal arteries, to narrow. The arteries can become blocked and this
can result in loss of vision.

How common is polymyalgia rheumatica?

Women develop polymyalgia rheumatica more often than men.


It most often appears in women over the age of 50.
Giant cell arteritis affects both men and women who are over the age of 50.
Some people who develop giant cell arteritis also have polymyalgia rheumatica.

Polymyalgia rheumatica predominantly affects Caucasian women over the age of 50. Giant cell
arteritis affects both men and women, usually over 50 years of age, who may or may not have
polymyalgia rheumatica.

What are the warning signs of polymyalgia rheumatica?

The warning signs of polymyalgia rheumatica include:

Severe pain and stiffness in the neck, shoulders, lower back, hips or thighs

Low energy and fatigue.


Profuse sweating during sleep. This is called night sweats.
Loss of appetite.
Slight fever.
Anaemia (pronounced a-nee-mee-a). This is a condition of the blood that can cause a
person to look pale, and feel weak, sleepy and dizzy.
Depression.

The warning signs of giant cell arteritis include:


Tenderness of skin on the forehead.
Redness and swelling of the blood vessels on the side of the head. These may be
painful to press on.
Changes in vision such as blurred vision, blind spots or seeing double.
Pain in the jaw, often while chewing food.
Dizziness.
Problems with hearing.
Sore throat and coughing.

If you have polymyalgia rheumatica you will probably experience muscle pain and stiffness in
specific parts of your body, usually the neck, shoulder, lower back, hips and/or thighs. However,
there are a variety of other symptoms that may indicate the presence of polymyalgia rheumatica.
With giant cell arteritis, the whole upper front side of the head will become extremely tender. The
larger arteries on the side of the skull redden, swell, and are painful when pressed. Other
symptoms include changes in vision such as blurring, blind spots, or seeing double; pain in jaw,
especially while chewing; dizziness; hearing problems and sore throat or cough.
The danger of giant cell arteritis is that it can cause blindness. Therefore, if you have already
been diagnosed with polymyalgia rheumatica and develop any of the giant cell arteritis, contact
your doctor immediately.

What causes polymyalgia rheumatica?

The exact cause of polymyalgia rheumatica is not known.


Some people with polymyalgia rheumatica have other family members with it.

No one knows what causes polymyalgia rheumatica. Genetic factors may play a part, and so the
disease might be hereditary.

What can you do about polymyalgia rheumatica?

If your doctor thinks you have polymyalgia rheumatica, he or she may refer you to a
rheumatologist (room-a-tol-o-jist). A rheumatologist is a doctor who has received special
training in the diagnosis and treatment of problems with muscles, joints and bones.

Your doctor may order certain laboratory tests. He or she might perform a test called an
EMG. This test measures the electric current in your muscles. He or she might also cut
away a very small piece of muscle to be tested in a laboratory.
The treatment of polymyalgia rheumatica is done to reduce the pain. The disease usually
goes away on its own, but this can take a long time.
Learn as much as you can about this disease. Speaking with people who are specialists
in arthritis care can provide you with the information you need.

To be able to diagnose whether you have polymyalgia rheumatica, your doctor will perform a
physical examination and probably order laboratory tests. One test, called a biopsy, involves
cutting away a very small segment of muscle tissue for analysis. If you have polymyalgia
rheumatica you will have an elevated erythrocyte sedimentation rate (ESR). This means that you
have a higher level of red blood cells that are settling in the muscle. Your doctor may also
perform a test called an EMG. With this test electrodes are taped to your skin and the electric
currents running through your muscles are recorded.
To test for giant cell arteritis, your doctor may perform a biopsy of a very small amount of tissue
from the inflamed area. If you have giant cell arteritis the tissue will contain cells that are larger
than normal and that have multiple nuclei (or centres). These are called 'giant' cells.
Giant cell arteritis also goes away on its own over a period of years. However, treatment is
essential to minimize the chances of blindness.
Your active involvement in developing your prescribed treatment plan is essential.

Medicine

Non-steroidal anti-inflammatory drugs (NSAIDs - pronounced en-seds) are sometimes


used to treat polymyalgia rheumatica. These are a type of medication that helps reduce
pain and swelling and decrease stiffness.

NSAIDs reduce pain when taken at a low dose, and relieve inflammation when taken at a higher
dose. NSAIDs such as ASA (Aspirin, Anacin, etc.) and ibuprofen (Motrin IB, Advil, etc.) can be
purchased without a prescription. Examples of NSAIDs that require a prescription include
Naprosyn, Relafen, Indocid, Voltaren, Feldene, and Clinoril. The various NSAIDs and Aspirin, if
taken in full doses, usually have the same levels of anti-inflammatory effect. However, different
individuals may experience greater relief from one medication than another. Taking more than
one NSAID at a time increases the possibility of side effects, particularly stomach problems such
as heartburn, ulcers and bleeding. People taking these medications should consider taking
something to protect the stomach, such as misoprostol (Cytotec).

Oral cortisone is most often prescribed for polymyalgia rheumatica and for giant cell
arteritis. Cortisone is a steroid that reduces inflammation.

Cortisone is a steroid that reduces inflammation and swelling. It is a hormone naturally produced

by the body. Corticosteroids are man-made drugs that closely resemble cortisone. The most
common form of corticosteroid is called prednisone, taken in pill form. Prednisone use needs to
be carefully monitored because of its many side effects, and the drug must never be stopped
abruptly. Some of the side effects from long-term use include cataracts, high blood pressure,
sleep problems, muscle loss, bruising, thinning of the bones (osteoporosis), weight gain and
increased risk of infections. For treatment of polymyalgia rheumatica the dose is rapidly
decreased to the lowest doses possible. These doses may need to be maintained for some time:
anywhere from 18 months to three years. The goal with this and most drugs is to find the lowest
effective dose that will avoid as many of the side effects as possible.

Exercise

Exercise may help reduce pain and will keep muscles from becoming weak.
The key is to strike a balance between too much activity (which can strain painful
muscles), and too little activity (which can increase pain and stiffness and lead to further
weakness).
There are three types of exercises:
Range of motion exercises reduce stiffness and help keep your joints moving. A range of
motion exercise for your shoulder would be to move your arm in a large circle.
Strengthening exercises maintain or increase muscle strength
Endurance exercises strengthen your heart and give you energy. These exercises include
walking, swimming and cycling.

Muscles and the other tissues that hold joints together weaken when they aren't moved enough,
so the joint loses its shape and function. Exercise may help reduce the pain of polymyalgia and
can help you feel better overall. Moderate stretching exercises will help relieve pain and keep the
muscles and tendons more flexible and strong. Low-impact exercises like swimming, walking,
water aerobics and stationary bicycling can all reduce pain while maintaining strength and
flexibility. Always consult a doctor before beginning an exercise program.

Heat/Cold

Applying heat helps relax aching muscles, and reduces pain and soreness. For example,
take a hot shower.
Applying cold helps to lessen the pain and swelling. For example, put an ice pack on the
area that is sore.

Heat or cold application can provide temporary relief of pain. Heat helps to reduce pain and
stiffness by relaxing aching muscles and increasing circulation to the area. There is some
concern that heat may worsen the symptoms in an already inflamed joint. Cold helps numb the
area by constricting the blood vessels and blocking nerve impulses in the joint. Applying ice or
cold packs appears to decrease inflammation and therefore is the method of choice when joints
are inflamed.

Protect Your Muscles and Joints

Be kind to your body. After doing heavy work, or doing the same task over and over,
stop. Slow down by doing an easy task, or by taking a rest.
Use your back, arms and legs in safe ways to avoid putting stress on muscles and joints.
For example, carry a heavy load close to your body.
Use helpful devices such as a cart to carry your grocery bags, or an enlarged handle that
fits over a knife handle so you can hold it easily. A cart will help you to walk more safely.
A grab bar, which attaches to a shower, will help you to get in and out of the tub more
easily.
Maintain a healthy weight to avoid putting extra stress on your joints.

Protecting your muscles and joints means using them in ways that avoid excess stress. Benefits
include less pain and greater ease in doing tasks. Three main techniques to protect your
muscles and joints are:
Pacing, by alternating heavy or repeated tasks with easier tasks or breaks, reduces the stress on
painful joints and allows weakened muscles to rest.
Positioning muscles and joints wisely helps you use them in ways that avoid extra stress. Use
larger, stronger joints to carry loads. For example, use a shoulder bag instead of a hand-held
one. Also, avoid keeping the same position for a long period of time.
Using helpful devices, such as canes, luggage carts, grocery carts and reaching aids, can help
make daily tasks easier. Using grab bars and shower seats in the bathroom can help you to
conserve energy and avoid falls.

By maintaining a healthy weight you also reduce stress on your joints and muscles. If you
plan to lose weight, discuss the best program for you with your doctor and a dietitian.
Relaxation

Relaxing the muscles around an inflamed area reduces pain.


There are many ways to relax. Try deep breathing exercises. Listen to music or
relaxation tapes. Meditate or pray. Another way to relax is to imagine or visualize a
pleasant activity such as lying on a beach, or sitting in front of a fireplace.

Developing good relaxation and coping skills can give you a greater feeling of control over your
arthritis and a more positive outlook.

Outcomes
Polymyalgia rheumatica usually goes away of its own accord, but it is impossible to predict how
long the disease will last in any person. Once the pain and stiffness of polymyalgia rheumatica
lessen, all patients are encouraged to resume their normal activities, trying to strike a balance
between too much activity (which can strain painful muscles), and too little activity (which can
increase pain and stiffness) and lead to further weakness.
Giant cell arteritis appears to run its course over a three to five year period with severe pain
gradually disappearing. There is also the possibility of loss of vision. However, with treatment,

pain subsides and vision loss is rare. The symptoms may recur months or even years after the
first episode.

Additional Tips for Living Well

The Arthritis Society offers a variety of programs and services that can be helpful.
You can reach the Society at 1-800-321-1433 from anywhere in Canada.
You can also reach us through our Web site at www.arthritis.ca

Along with the physical symptoms of arthritis, many people experience feelings of helplessness
and depression. Learning daily living strategies to manage your arthritis gives you a greater
feeling of control and a more positive outlook. To get the best results, people affected by arthritis
need to form close ties with their doctors and therapists, and become full partners in their
treatment. From our perspective, it's all part of 'living well with arthritis.' There are several
resources you can use in finding out how best to manage your own arthritis. Here are a few:

The Arthritis Self-Management Program (ASMP) is a unique self-help program


offered by The Arthritis Society to help you better control and manage your arthritis.
The Open Forum within this Web site is an opportunity to discuss and share information
with other visitors - people who, through their own experiences, may be able to offer
some useful insights.

Of course, there are many other valuable resources for people with arthritis. If you're unclear
about where to look for help, be sure to call The Arthritis Society at 1-800-321-1433.