Polymyalgia Rheumatica Treatment in Riverside, CA

Overview of Polymyalgia Rheumatica and Giant Cell Arteritis

Polymyalgia rheumatica and giant cell arteritis are closely linked diseases. Both cause inflammation, which is swelling and irritation inside the body. They almost always start in people older than 50.

Polymyalgia rheumatica causes muscle pain and stiffness in the shoulders, upper arms and hips. Sometimes it affects the neck, too. The ache and stiffness are usually worse in the morning or after you have been still for a while. They can be bad enough to make daily life hard. They tend to get better when you move.

Some people with polymyalgia rheumatica also have giant cell arteritis. This disease causes swelling in the arteries. It mostly affects the arteries on each side of the head and scalp. It can also affect the aorta, which is the large artery that carries blood from the heart, and its main branches. Headaches, a sore scalp and jaw pain are common signs. If it affects the blood vessels that feed the eyes, it can cause vision problems. These include short or lasting vision loss, or double vision. Get treatment right away if you have vision symptoms. Without treatment, they could lead to lasting blindness. Giant cell arteritis is also called temporal arteritis or Horton disease.

Both diseases usually get better with treatment. But it is common for symptoms to come back when treatment is lowered or stopped.

Who Gets Polymyalgia Rheumatica and Giant Cell Arteritis?

Some things make you more likely to get these diseases:

• Age. They almost only happen in people older than 50. Most people are in their late 60s or 70s.
• Sex. Women get them more often than men.
• Background. They are more common in White people, most of all people whose families came from northern Europe. But people of other backgrounds get them, too.

Symptoms of Polymyalgia Rheumatica and Giant Cell Arteritis

These two diseases are related. Some people have symptoms of both. About 10 percent of people with polymyalgia rheumatica have giant cell arteritis. About 50 percent of people with giant cell arteritis have polymyalgia rheumatica.

Symptoms of polymyalgia rheumatica include:

• Pain and stiffness in the shoulders, neck, upper arms and hips. It is usually worse when you wake up or after you rest. It usually lasts an hour or more. It may be hard to get out of bed or up from a chair, to get dressed or to brush your hair. It is also common to have trouble raising your arms above your shoulders.
• Flu-like symptoms, such as a mild fever, weakness, not feeling hungry and weight loss.
• Sometimes, swelling of the wrists or the joints in the hands.

Symptoms of polymyalgia rheumatica can come on fast. It usually takes a few days. In some cases, it happens overnight.

Symptoms of giant cell arteritis include:

• Headaches and a sore scalp. These are the most common signs. The headache can be severe. It is usually at the temples, on the sides of the head. Some people notice a sore scalp before the headaches start.
• Jaw pain. It is most common when chewing.
• Vision problems. Many people have bouts of double vision or lose vision in one or both eyes. At first, these may last only a few minutes and go away on their own. See a health care provider right away if you have vision symptoms. Without treatment, they can lead to lasting vision loss within hours or days.
• Flu-like symptoms, such as a mild fever, weakness, not feeling hungry and weight loss.
• Problems in large arteries. Swelling of the aorta and its main branches can make the artery bulge. This is called an aneurysm. Blocked arteries can also cause cramps or aching in the arms or legs when you use them. Sometimes swelling of the aorta causes no symptoms. It is found by chance on a scan, such as a CT or MRI.

In most people, symptoms of giant cell arteritis build over weeks or months. In some people, they start all of a sudden. Some people have problems only in the large arteries, such as the aorta, and none in the head or scalp. They may have flu-like symptoms or no symptoms at all.

Cause of Polymyalgia Rheumatica and Giant Cell Arteritis

Inflammation causes both diseases. But scientists do not know what sets it off. Some studies have linked certain genes to these diseases. But the links have not been the same in different groups of people. Because the diseases happen in older people, aging may play a part.

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Diagnosis of Polymyalgia Rheumatica and Giant Cell Arteritis

No single test can show if you have polymyalgia rheumatica or giant cell arteritis. Your doctor will usually:

• Ask about your health history and examine you. They will likely check the arteries at your temples for swelling or soreness. These are signs of giant cell arteritis.
• Order blood tests, such as the sed rate (ESR) and C-reactive protein (CRP). These tests measure inflammation. But they do not point to these two diseases alone. A high result can mean any disease that causes inflammation.

Your doctor may also:

• Take a biopsy of the artery at your temple if they think you have giant cell arteritis. A small piece of the artery is removed after the area is numbed. A specialist checks it under a microscope for signs of inflammation.
• Order scans. An ultrasound, PET scan, CT scan or MRI can show signs of these diseases, such as swelling in large blood vessels. Scans can also help rule out other diseases.
• Send you to an eye doctor (ophthalmologist) if you have worrying vision symptoms.

Treatment of Polymyalgia Rheumatica and Giant Cell Arteritis

For polymyalgia rheumatica, the main goal is to ease symptoms. For giant cell arteritis, the goals are to ease symptoms and to prevent vision loss and other problems.

The main treatment for both diseases is:

• Corticosteroids. These medicines calm inflammation. They are the main treatment for both diseases. For polymyalgia rheumatica, doctors usually prescribe low to medium doses taken by mouth. For giant cell arteritis, they prescribe higher doses. Most people get better within days to weeks. Once symptoms go away, the dose is usually lowered slowly. You may stay on a small dose for a year or longer. Because these are strong medicines, your doctor will give you the lowest dose that works.

Your doctor may also prescribe:

• Disease-modifying antirheumatic drugs (DMARDs). These medicines are approved for other diseases. They work on inflammation inside the cells. Doctors may give them with corticosteroids. This is most common in people who have side effects from corticosteroids, or to calm a flare.
• Biologic medicines. These are also DMARDs. They block certain signals the immune system sends, which helps lower or stop inflammation. They are sometimes given with corticosteroids to people with giant cell arteritis.

Corticosteroids can lead to osteoporosis, a disease that makes bones weak and easy to break. So your doctor may also give you medicine to make your bones stronger.

Who Treats Polymyalgia Rheumatica and Giant Cell Arteritis?

These diseases are mostly treated by:

• Rheumatologists. They are experts in arthritis and other diseases of the joints, bones, muscles and immune system.
• Primary care doctors, such as family doctors or internal medicine doctors.

Other providers may also help with your care:

• Eye doctors (ophthalmologists), when giant cell arteritis affects the eyes.
• Heart doctors (cardiologists) or blood vessel surgeons, when giant cell arteritis affects the aorta and its main branches.
• Mental health professionals. They help people cope with problems at home and at work that may come from their health.
• Physical therapists. They help you live better through exercise, hands-on care and teaching.

Living With Polymyalgia Rheumatica and Giant Cell Arteritis

Corticosteroids can cause side effects, even at low doses. Tell your doctor if you have any of them. Side effects include:

• A higher risk of infections.
• Mood swings.
• Trouble sleeping.
• High blood pressure.
• Eye problems, such as cataracts or glaucoma.
• Diabetes.
• Osteoporosis (thin, weak bones).
• Weight gain.
• Swelling of the face, legs or other parts of the body.
• Loss of muscle.

If you notice any of these side effects, your doctor may need to change your dose. These tips can help you avoid side effects:

• Protect your bones. Get enough calcium and vitamin D. Do exercises where you stand and bear your weight, such as walking.
• Eat a healthy, balanced diet and exercise regularly. This helps you avoid weight gain and lowers your risk of diabetes and high blood pressure.
• If you smoke, ask your doctor to help you make a plan to quit. Smoking can harm your bones and heart.

It is also important to:

• See your health care providers regularly and follow their advice.
• Talk to your doctor before you start an exercise program. They may send you to a physical therapist. A physical therapist can make a plan to help you be more active and manage pain.
• Talk to a mental health professional or join a support group if you feel anxious or depressed. Living with these diseases can be hard at times. Sharing your story with others may help.

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