Polymyalgia Rheumatica and Giant Cell Arteritis
Pronounced: Pol-ee-my-al-ja Roo-MAT-ic-ahEn Español (Spanish Version)
Polymyalgia rheumatica (PMR) is an inflammatory disorder that results in muscle pain and stiffness in the body. It especially effects the shoulders, arms, hips, and thighs. Often, many people who have PMR (about 15%) also develop another syndrome called giant cell arteritis (GCA). GCA results in inflammation and swelling of arteries, most commonly in the head. If not treated quickly, GCA may cause permanent blindness.
Giant Cell Arteritis
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There is some evidence to suggest that certain viruses could be responsible for the onset of the disease. The exact causes and relationship between PMR and GCA are unknown. Both are inflammatory conditions, and therefore are due to some kind of immune system dysfunction. Genetic factors contribute to their development as well.
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for PMR and GCA include:
- Age: 50 and older
- Sex: female
- Ethnicity: PMR is most common in Caucasians, particularly those from northern Europe
Symptoms of PMR often develop within two weeks. They may include:
- Muscle pain and/or stiffness in the hip, shoulder, or neck areas
- Stiffness in the morning
- Unexplained weight loss
- Mood changes
Symptoms of GCA may include:
- All PMR symptoms
- Headache, sometimes very severe, may also be associated with scalp hypersensitivity to touch
- Pain or tenderness in the temple
- Changes in vision
- Pain in the jaw or tongue with chewing
If you suspect GCA, contact a doctor immediately. Without treatment, this condition may lead to permanent blindness.
Your doctor will ask about your symptoms and medical history, and perform a physical exam. There is no single test for PMR. However, to support the diagnosis and rule out other conditions, tests may include:
- Erythrocyte sedimentation rate (ESR)—a blood test that measures how quickly red blood cells fall to the bottom of a test tube. In the case of inflammation, levels of fibrinogen increase in the blood. Fibrinogen makes the red blood cells clump, making them fall faster.
- Rheumatoid factor (RF)—a blood test that measures whether a specific antibody (RF) is present in the blood. Patients with a positive RF test usually have an inflammatory condition other than PMR (frequently rheumatoid arthritis).
- Complete blood count—a blood test that measures the amount of different blood cells present in whole blood. Patients with GCA or PMR often have anemia and patients with PMR have elevated levels of platelets.
- C-reactive protein—a protein produced in the liver. Its increased levels indicate an inflammatory state.
- Muscle biopsy—removal of a sample of muscle tissue for examination (rare)
If you have PMR, your doctor may also consider the possibility of GCA. Evaluation for GCA includes:
- Physical exam, including vision test
- Biopsy of an affected blood vessel is necessary to confirm the diagnosis
Symptoms of PMR will disappear without treatment within several months to years. However, treatment leads to dramatic improvement within 24-48 hours. Treatment usually consists of:
- Corticosteroid medication
- Anti-inflammatory drugs
Giant Cell Arteritis
GCA must be treated before blindness occurs, because blindness is irreversible. Treatment is usually a high dose of corticosteroid medication for about one month. This is then tapered to a smaller dose for maintenance therapy, usually for at least 1-2 years.
American College of Rheumatology
The Arthritis Society
American College of Rheumatology website. Available at: http://www.rheumatology.org/public/factsheets/pmr_new2.asp . Accessed March 25, 2007.
Eberhardt RT, Dhadly M. Giant cell arteritis: diagnosis, management, and cardiovascular implications. Cardiol Rev . 2007 Mar-Apr;15(2):55-61. Review.
National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/hi/topics/polymyalgia/ . Accessed March 25, 2007.
Soubrier M, Dubost JJ, Ristori JM. Polymyalgia rheumatica: diagnosis and treatment. Joint Bone Spine . 2006 Dec;73(6):599-605. Epub 2006 Oct 12. Review.
Last reviewed March 2008 by Marcin Chwistek, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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