Polymyalgia Rheumatica

What is Polymyalgia Rheumatica?

Polymyalgia is an inflammatory condition affecting the body. People who are affected by Polymyalgia usually experience aches and pains and stiffness around the shoulders and the hip areas. It is usually associated with high levels of inflammation which can be measured in the blood. Inflammation in the blood is measured by markers called the ‘ESR’ and ‘CRP’.

The name Polymyalgia Rheumatica comes from Greek and in simple translation it means ‘many aches in the muscles’. It is often referred to as ‘Polymyalgia’ or abbreviated to PMR for short.
What does Polymyalgia Rheumatica feel like? ie, what are the symptoms
People with Polymyalgia Rheumatica usually have a lot of stiffness around the shoulders and the hips. It usually affects both sides, but it can start on one side before progressing to involve both sides.

Usually people feel a lot worse in the morning, and find it very difficult to turn over in bed. The aches and pains can improve towards the end of the day before then getting worse in the night time. Sometimes people can also have aches and pains in joints such as the hands and feet, sometimes with swelling too.

Polymyalgia Rheumatica usually starts to affect people gradually; it comes on over time. It is unusual for it to occur ‘over night’.

When affected by polymyalgia, people can feel depressed, generally exhausted, and generally unwell. Low grade fevers may occur. People can also lose their appetite – both for food, and life.

Who gets Polymyalgia Rheumatica?

Usually Polymyalgia affects people over the age of 60.

If you have typical symptoms of polymyalgia but are younger than 60 it is very important that these pains are investigated for another cause. This is important because the treatment could be very different. Your Rheumatologist can do this.

Polymyalgia affects men and women, although women are 2-3 times more likely to be affected than men.

What causes Polymyalgia Rheumatica?

As yet, conventional medicine does not have an understanding of what causes Polymyalgia Rheumatica.

How is Polymyalgia Rheumatica treated?

Prednisolone (often called ‘steroids’) is the medicine used. Usually polymyalgia responds very well to 15-20mg of prednisolone (tablets).

If the stiffness and the aches do not improve with 20mg of prednisolone it is very likely that Polymyalgia Rheumatica is not the cause of your stiffness and aches.
How long is treatment needed?

Every body is different. The duration of the treatment can range anywhere from 9 months to 2 years. The duration of the treatment is guided by how each person responds to the prednisolone.

The dose of the prednisolone is gradually reduced over several months. If the stiffness and the inflammation returns when the dose of the prednisolone is reduced, then an increase in the dose of the drug and an increase in the duration of treatment may be needed.

Some people may need to be on a very small dose of prednisolone indefinitely to control their symptoms.

Are there side effects from the treatment?

Prednisolone is not a pleasant drug to be on for many people at the doses of 15 or 20mg. As the dose is reduced down to 10mg and under, people tend to feel better. Unfortunately, it is the only medicine to treat Polymyalgia Rheumatica. In the short term, people can experience some mood disturbances, some puffiness and a bit of weight gain, sometimes blood sugars can increase, blood pressure can increase a little bit.

The most common thing that I hear from people is that it is a bit difficult to go to sleep at night and they feel like eating more. These feelings usually go away when the dose is reduced, and when the drug is stopped.

In the long term, prednisolone is associated with more side effects, and these effects are usually related to the dose that is being taken. The most significant ones are osteoporosis, diabetes, hypertension and glaucoma. Recent evidence suggests that long term 5mg prednisolone is not associated with significant long term side effects.

Does Polymyalgia Rheumatica go away?

Prednisolone is a very good treatment. Usually all the feelings of the polymyalgia are gone within 24-48 hours of starting the medicine.

If you are responding to the treatment you will have no aches or pains or stiffness while you are taking the steroids (prednisolone).

The steroids are needed for as long as there is stiffness and inflammation. Polymyalgia is usually gone within 9 months-2 years. If it is gone, you do not need to be on steroids.

How is Polymyalgia Rheumatica diagnosed?
Polymyalgia is diagnosed by the story and pattern of the way the body is feeling, in combination with blood tests.
It is important to look for other conditions that also have stiffness and aches. Things that can feel like Polymyalgia are Rheumatoid Arthritis, Seronegative Arthritis, Giant Cell Arteritis (often known as Temporal Arteritis).

Sometimes certain cancers such as Myeloma can create aches in the body. Vitamin D deficiency and vitamin C deficiency can also cause aches around the shoulder and the hips. It is also important for the thyroid and adrenal glands to be tested as hormone deficiencies can also cause aches and pains in the body.

If you have aches and pains around the shoulders and the hips, but no inflammation in the blood, it is very important that your doctor investigates for other possible causes.  It is not common for there to be no inflammation in the blood with polymyalgia rheumatica.
Frequently Asked Questions
  • Can any other drug be used to treat polymyalgia?

Unfortunately, prednisolone is the best drug to treat it.

  • Can polymyalgia come back?

Yes, but this is not common.

  • Will I be on steroids for ever?

Usually, people are off steroids between 9 months and 2 years, depending on how their condition progresses. In some cases, people may need to be on long term prednisolone of anywhere between 1 and 5 mg. In some cases, this is because the polymyalgia is active, but in others it can be because they have adrenal exhaustion and need ongoing low dose prednisolone to support their body.

  • Is there an overlap with Giant Cell Arteritis (GCA)?

Yes, 15% of people with Polymyalgia Rheumatica get Giant Cell Arteritis, and 50% of people with Giant Cell Arteritis have Polymyalgia.