Polymyalgia rheumatica

Polymyalgia rheumatica | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Polymyalgia rheumatica Polymyalgia rheumatica About polymyalgia rheumatica Symptoms of polymyalgia rheumatica Diagnosing polymyalgia rheumatica Treating polymyalgia rheumatica About polymyalgia rheumatica Polymyalgia rheumatica (PMR) is a condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips. The main symptom is musclestiffness in the morning that lasts longer than 45 minutes. It may also causeother symptoms, including: high temperature (fever) and sweating extreme tiredness (fatigue) loss of appetite weight loss depression If you have pain and stiffness that lasts longer than a week, you should see your GP so the cause can be investigated. Diagnosing polymyalgia rheumaticacan be difficult because the symptoms are similar to those of many other conditions, including rheumatoid arthritis . These conditions will need to be ruled out before polymyalgia rheumatica is diagnosed. Read more about the symptoms of polymyalgia rheumatica and diagnosing polymyalgia rheumatica . What causes polymyalgia rheumatica? The cause of polymyalgia rheumatica is unknown, but a combination of genetic and environmental factorsis thought to be responsible. Polymyalgia rheumatica is relatively common in the UK. Its estimated that one in every 1,200 people develop the condition every year. Polymyalgia rheumatica isage-related. Most people who are diagnosed with the condition are over 70. Its extremely rare in people younger than 50. Its also more common in women than men. Treating polymyalgia rheumatica The main treatment forpolymyalgia rheumatica is a coritcosteroid medication called prednisolone, which is used to help relieve the symptoms. Youllinitiallybe prescribed a high dose of prednisolone, which will be reduced gradually over time. Most people with polymyalgia rheumatica will need to take a long-term course of corticosteroid treatment(lasting 18 months to two years) to prevent their symptoms returning. Read more about treating polymyalgia rheumatica . Symptoms of polymyalgia rheumatica 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. The muscles in the neck andhips are also often affected. Both sides of the body are usually affected. The stiffness often feelsworse first thing in the morning after you wake up and starts to improve after about 45 minutes as you become more active. Some people withpolymyalgia rheumatica have additional symptoms, including: a mild high temperature (fever) of 37-38C (98.6-100.4F) depression fatigue (extreme tiredness) loss of appetite weight loss When to seek medical advice If you have symptoms of pain and stiffness that last longer than a week, you should make an appointment to see your GP so that the cause can be investigated. When to seek immediate medical advice You should seek immediate medical advice if you have been diagnosed with polymyalgia rheumatica (or the condition is suspected) and you suddenly develop: a persistent and severe headache jaw pain or cramping in your jaw muscles which is worse when youre eating pain in the tongue when chewing vision lossor vision disturbances, such asdouble vision These symptoms may indicate a more serious condition called giant cell arteritis (temporal arteritis). Call your GP immediately for adviceif you have any of the above symptoms. If this isnt possible,contact your local out of hours service or call theNHS 24 111 service. Diagnosing polymyalgia rheumatica Diagnosing polymyalgia rheumatica (PMR) can often be quite a lengthy process that involves several different tests. This is because the condition shares many symptoms with more common health conditions, such as rheumatoid arthritis , which need to be ruled out first. Tests Theres no specific test for polymyalgia rheumatica, but its likely that a series of blood tests will be carried out. Two blood tests  erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)  can be used to check the levels of inflammation in your body. If the ESR and CRP test results are normal, its unlikely that polymyalgia rheumatica will be diagnosed because your doctor wont want to prescribe a long-term course of steroids if the diagnosis is uncertain. Sometimes, the ESR may be normal and CRP may be raised, which would be more likely to indicate a positive diagnosis. This is why both tests are usually carried out at the same time. As inflammation is a characteristic of many conditions, high levels dont automatically mean that you have polymyalgia rheumatica. Further tests may be needed to help rule out other conditions that cause inflammation. For example, a test for rheumatoid factor and anti-CCP antibodies , may be carried out to rule out rheumatoid arthritis. Blood tests can also help determine: whether theres an infection in your blood how well some of your organs, such as your kidneys, are working whether you have an overactive thyroid gland or an underactive thyroid gland (both conditions can cause muscle pain) You may also have a urine test to check how well your liver is functioning. X-rays and ultrasound scans may also be used to look at the condition of your bones and joints. Symptom checklist After other possible causes of your symptoms have been ruled out, a checklist can be used to see whether your symptoms match those most commonly associated with polymyalgia rheumatica. A confident diagnosis of polymyalgia rheumatica can usually be made if you meet all of the following criteria: youre over 50 years of age you have pain in your shoulders or your hips you have stiffness in the morning that lasts longer than 45 minutes your symptoms have lasted longer than two weeks blood tests show raised levels of inflammation in your body your symptoms rapidlyimprove after treatment with corticosteroids Read more about treating polymyalgia rheumatica . Treating polymyalgia rheumatica Steroid medication ( corticosteroids ) is the preferred treatment for polymyalgia rheumatica (PMR). A type of corticosteroid calledprednisolone is usually prescribed. Prednisolone Prednisolone works by blocking the effects of certain chemicals that cause inflammation inside your body. It doesnt cure polymyalgia rheumatica, but it can helprelieve 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. Youll be prescribed a high dose of prednisolone initially, and the dose will be gradually reduced every one to two months. Although your symptoms should improve within a few days of starting treatment, youll probablyneed to continue takinga low dose of prednisolone forabout two years. In many cases, polymyalgia rheumatica improves on its own after this time. However, theres a chance that the condition will return (relapse)once treatment stops. Dont suddenly stop taking steroid medication unless a doctor in charge of your care tells you its safe to do so. Suddenly stopping treatment with steroids can make you feel very ill. Side effects of prednisolone Aboutone in 20 people who take prednisolone will experience changes in their mental state when they take the medication. You may feel depressed and suicidal , anxious or confused. Some people also experience hallucinations (seeing or hearing things that arent there). Contact your GP as soon as possible if you experience changes to your mental state. Other side effects of prednisolone include: increased appetite that often leads to weight gain increased blood pressure mood changes, such as becoming aggressive orirritable with people weakening of the bones ( osteoporosis ) stomach ulcers increased risk of infection, particularly with thevaricella-zoster virus (the virus that causes chickenpox and shingles ) Seek immediate medical advice if you think youve been exposed to the varicella-zostervirus, 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. See side effects of corticosteroids for more information about how these side effects may affect you and how theyre treated. Other medications Sometimes, other medicines may be combined with corticosteroids to help prevent relapses or to allow your dose of prednisolone to be reduced. Some people are prescribed immunosuppressant medication, such as methotrexate. This is used to reduce or suppress the immune system (the bodys defence against infection and illness). It may be helpful for people with polymyalgia rheumatica who have frequent relapses or dont respond to normal steroid treatment. Your doctor may recommend painkillers, such as paracetamol , or non-steroidal anti-inflammatory drugs (NSAIDs) , to help relieve pain and stiffness while your dose of prednisolone is reduced. Follow-up Your GP will ask you to attend regular follow-up appointments to check how well youre responding to treatment, whether your dose of prednisolone needs to be adjusted, and how well youre coping with the side effects of the medication. During these appointments, youll have blood tests to check the levels of inflammation inside your body. Follow-up appointments are usually recommended every few weeks for the first three months and then at three- to six-monthly intervals after this time. Contact your GP if your symptoms returnduring any part of your treatment. Your dosage may need to be adjusted. Source: MSK Expert Panel - Opens in new browser window Last updated: 13 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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