Overview

Symptoms of polymyalgia rheumatica

• extreme tiredness
• loss of appetite
• weight loss
• depression

See a GP if you have pain and stiffness for more than a week. They'll try to find out what's causing it.

Diagnosing polymyalgia rheumatica can be difficult because the symptoms are similar to those of many conditions, including rheumatoid arthritis.

These conditions will need to be ruled out before polymyalgia rheumatica is diagnosed.

Causes of polymyalgia rheumatica

The cause of polymyalgia rheumatica is unknown, but a combination of genetic and environmental factors is thought to be responsible.

Polymyalgia rheumatica is an age-related condition. Most people diagnosed with it are over 70, and it's very rare in people younger than 50. It's also more common in women than men.

It's estimated 1 in every 1,200 people in the UK develop the condition every year.

Treating polymyalgia rheumatica

A corticosteroid medicine called prednisolone is the main treatment for polymyalgia rheumatica. It's used to help relieve the symptoms.

To start with, you may be prescribed a moderate dose of prednisolone, which will be gradually reduced over time.

Most people with polymyalgia rheumatica will need a course of corticosteroid treatment that lasts for 18 months to 2 years to prevent their symptoms returning.

Temporal arteritis

Up to 1 in 5 people with polymyalgia rheumatica develop a more serious condition called temporal arteritis (also known as giant cell arteritis), where the arteries in the head and neck become inflamed.

Symptoms of temporal arteritis include:

• a severe headache that develops suddenly (your scalp may also feel sore or tender)
• pain in the jaw muscles when eating
• problems with sight, such as double vision or loss of vision

If you have any of these symptoms, contact a GP immediately, call 111, or go to your nearest Accident and Emergency department.

Unlike polymyalgia rheumatica, temporal arteritis requires immediate medical attention. This is because it can cause permanent sight loss if not treated promptly.

Symptoms

The most common symptom of polymyalgia rheumatica (PMR) is pain and stiffness in the shoulder muscles, which develops quickly over a few days or weeks.

You may also have pain in your neck and hips. Both sides of the body are usually affected.

The stiffness is often worse first thing in the morning after you wake up. It starts to improve after about 45 minutes as you become more active.

Some people with polymyalgia rheumatica also:

• feel very tired
• lose their appetite
• lose weight
• have depression

When to get medical advice

See a GP if you have pain and stiffness that lasts longer than a week. They'll investigate the cause.

When to get immediate medical advice

Contact a GP immediately, use NHS 111 or go to your nearest Accident & Emergency department if you've been diagnosed with polymyalgia rheumatica (or it's suspected) and you suddenly have:

• a severe headache that does not go away
• pain or cramping in your jaw muscles that's worse when eating
• pain in your tongue when chewing
• vision loss or vision disturbances, such as double vision

These symptoms may indicate a more serious condition called temporal arteritis.

Diagnosis

Tests

• whether you have a blood infection
• how well your organs, such as your kidneys, are working
• if you have an overactive thyroid gland or an underactive thyroid gland - both conditions can cause muscle pain

You may have a urine test to check how well your kidneys are functioning.

X-rays and ultrasound scans may also be used to look at the condition of your bones and joints.

Symptom checklist

After ruling out other possible causes of your symptoms, a checklist can be used to see if your symptoms match those most commonly associated with polymyalgia rheumatica.

Polymyalgia rheumatica can usually be confidently diagnosed if you meet all of the following criteria:

• you're over 50 years of age
• you have pain in your shoulders or hips
• you have stiffness in the morning that lasts longer than 45 minutes
• your symptoms have lasted for more than 2 weeks
• blood tests show raised levels of inflammation in your body
• your symptoms rapidly improve after treatment with corticosteroids

Treatment

Steroid medication is the main treatment for polymyalgia rheumatica (PMR).

A type of corticosteroid called prednisolone is usually prescribed.

Prednisolone

Prednisolone works by blocking the effects of certain chemicals that cause inflammation inside your body. It does not cure polymyalgia rheumatica, but it can help relieve the symptoms.

When used to treat polymyalgia rheumatica, prednisolone is taken as a tablet. Most people will be prescribed several tablets to take once a day.

To start with, you may be prescribed a moderate dose of prednisolone. The dose will be gradually reduced every 1 to 2 months.

Although your symptoms should improve within a few days of starting treatment, you'll probably need to continue taking a low dose of prednisolone for about 2 years.

In many cases, polymyalgia rheumatica improves on its own after this time. However, there's a chance it will return after treatment stops. This is known as a relapse.

Do not suddenly stop taking steroid medicine unless your doctor tells you it's safe to stop. Suddenly stopping treatment with steroids can make you very unwell.

Side effects of prednisolone

About 1 in 20 people experience changes in their mental state when they take prednisolone.

You may feel depressed and suicidal, anxious or confused. Some people also have hallucinations, which is seeing or hearing things that are not there.

Contact a GP as soon as possible if you experience changes to your mental state.

Other side effects of prednisolone include:

• increased appetite, which often leads to weight gain
• high blood pressure
• mood changes, such as becoming aggressive or irritable with people
• weakening of the bones (osteoporosis)
• stomach ulcers
• increased risk of infection, particularly with the varicella-zoster virus, the virus that causes chickenpox and shingles

Get immediate medical advice if you think you've been exposed to the varicella-zoster virus or if a member of your household develops chickenpox or shingles.

The risk of these side effects should improve as your dose of prednisolone is decreased.

Find out more about the side effects of steroid tablets.

Other medicines

Sometimes other medicines may be combined with corticosteroids to help prevent relapses or allow your dose of prednisolone to be reduced.

Some people are prescribed immunosuppressant medicine, such as methotrexate. It's used to suppress the immune system, the body's defence against infection and illness.

It may help people with polymyalgia rheumatica who have frequent relapses or don't respond to normal steroid treatment.

Your doctor may recommend painkillers, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), to help relieve your pain and stiffness while your dose of prednisolone is reduced.

Follow-up

You'll have regular follow-up appointments to check:

• how well you're responding to treatment
• if your dose of prednisolone needs to be adjusted
• how well you're coping with any side effects

During these appointments, you'll have blood tests to check the levels of inflammation inside your body.

Follow-up appointments are usually recommended every few weeks for the first 3 months, and then at 3 to 6 monthly intervals after this time.

Contact a GP if your symptoms return during any part of your treatment. Your dosage may need to be adjusted.