Polymyalgia rheumatica

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 of middle age.
  • Giant cell arteritis affects both men and women who are often 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.
  • Anemia.  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.
  • Altered immunity has shown a casual link.

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.



  • 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 AspirinŽ, 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 but should be used with care due to the possible implications of fungal exposure.

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 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.

Warm pool therapy is highly recommended.  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.


  • 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.



  • 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.


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.

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This site is not intended to give medical advice.  Seek the advice of a professional for diagnosis, medication, treatment options, and complete knowledge of any illness.  The opinions expressed here are exclusively my personal opinions do not necessarily reflect my peers or professional affiliates. The information here does not reflect professional advice and is not intended to supersede the professional advice of others.