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  • Overview of Polymyalgia Rheumatica and Giant Cell Arteritis
  • Autoimmune Condition

Polymyalgia rheumatica and giant cell arteritis are closely linked inflammatory disorders that almost always occur in people older than age 50.

  • Understanding Polymyalgia Rheumatica and Giant Cell Arteritis
  • Autoimmune Condition

Polymyalgia rheumatica causes muscle pain and stiffness in the shoulders, upper arms, hip area, and sometimes the neck. The ache and stiffness are usually worse in the morning or when you have not been moving for a while. They can sometimes be very debilitating and tend to improve with activity. 

People with polymyalgia rheumatica sometimes have another disorder called giant cell arteritis, which is associated with inflammation of arteries, especially those located on each side of the head, scalp, and the aorta (the large artery that carries blood from the heart) and its main branches. Headaches, scalp tenderness, and jaw pain are common features of giant cell arteritis. If the blood vessels that nourish the eyes are affected, there may be visual problems such as fleeting or permanent vision loss or double vision. It is important to seek treatment right away if you have visual symptoms, because if left untreated, they may potentially lead to permanent blindness. Giant cell arteritis is also known as temporal arteritis and Horton’s disease.

Both disorders generally respond well to treatment, although it is common for symptoms to recur after decreasing or stopping therapy.

  • Who Gets Polymyalgia Rheumatica and Giant Cell Arteritis?
  • Autoimmune Condition

You are more likely to get polymyalgia rheumatica and giant cell arteritis if you have certain risk factors. These include:

  • Age. They occur almost exclusively in people older than age 50, typically in people in their late 60s and in their 70s.
  • Sex. Women get these disorders more frequently than men do.
  • Ethnic and racial background. They are more common in Caucasians, especially people of Northern European ancestry, but are also observed in patients of other ethnic and racial backgrounds.
  • Symptoms of Polymyalgia Rheumatica and Giant Cell Arteritis
  • Autoimmune Condition
Polymyalgia rheumatica and giant cell arteritis are related conditions, with some people having symptoms of both. About 10 percent of people with polymyalgia rheumatica have giant cell arteritis, and about 50 percent of those with giant cell arteritis have polymyalgia rheumatica.

Symptoms of polymyalgia rheumatica include:

  • Pain and stiffness in the shoulders, neck, upper arms, and hip area. The pain and stiffness are usually worse upon waking in the morning or after resting, and usually last an hour or more. You may have difficulty with activities like getting up from bed or a chair, dressing and brushing hair. It is also typical to have difficulty raising your arms above your shoulders.
  • Flu-like symptoms, including low-grade fever, weakness, loss of appetite, and weight loss.
  • Occasional swelling of the wrists or joints in the hands.

The symptoms of polymyalgia rheumatica can come on quickly, usually in a matter of a few days, and in some cases even overnight.

Symptoms of giant cell arteritis include:

  • Headaches and scalp tenderness. These are the most common symptoms. The headache pain may be severe and is usually located in the temple area. Some people notice tenderness of the scalp, often prior to the onset of headaches.
  • Jaw pain. People sometimes experience jaw pain, especially when chewing.
  • Visual disturbances. Many people have episodes of double vision or vision loss in one or both eyes. At first, the visual disturbances may last only a few minutes and resolve on their own. It is important to see a health care provider right away if you develop visual symptoms, because if left untreated, they can lead to permanent vision loss within hours or days.
  • Flu-like symptoms. These include low-grade fever, weakness, loss of appetite, and weight loss.
  • Large artery involvement, including inflammation of the aorta and its major branches, can lead to bulging of the artery (aneurysms) or, due to blockages in the arteries, cause cramping or aching pain in the arms or legs with activity. At times, inflammation of the aorta does not cause any symptoms but is detected by chance on imaging studies (such as CT or MRI).

In most people, symptoms of giant cell arteritis develop over the course of weeks or months, but in some cases the onset is more abrupt. Some people may have only large artery involvement (such as the aorta) and not have any symptoms in the head or scalp; these people may experience flu-like symptoms or no symptoms at all.

  • Cause of Polymyalgia Rheumatica and Giant Cell Arteritis
  • Autoimmune Condition

Inflammation causes polymyalgia rheumatica and giant cell arteritis, but scientists do not know what triggers it. Some studies have linked certain gene variants with the disorders, but these genetic links have not been consistent across different populations. Because the disorders occur in older people, the aging process may contribute to the disease onset.

  • Diagnosis of Polymyalgia Rheumatica and Giant Cell Arteritis
  • Autoimmune Condition

There is no single test to tell if you have polymyalgia rheumatica or giant cell arteritis. The doctor usually:

  • Takes your medical history and performs a physical exam. He or she will likely examine the temporal arteries for evidence of swelling or tenderness, signs of giant cell arteritis.
  • Orders blood tests, such as the erythrocyte sedimentation rate (ESR or “sed” rate) and C-reactive protein (CRP) test. These tests are measures of inflammation, but they are not specific for polymyalgia rheumatica or giant cell arteritis. They can indicate any inflammatory disorder.

The doctor may also:

  • Obtain a biopsy of the temporal artery if giant cell arteritis is suspected. The procedure is performed using a local anesthetic. A pathologist will examine the sample under a microscope and look for signs of inflammation.
  • Order imaging tests. An ultrasound, positron emission tomography (PET), computed tomography (CT), or magnetic resonance imaging (MRI) scan can reveal changes consistent with the disorders, such as swelling and inflammation in large vessels, or may help rule out other diseases and conditions.
  • Request consultation from specialists, such as an ophthalmologist, if concerning visual symptoms are occurring.
  • Treatment of Polymyalgia Rheumatica and Giant Cell Arteritis
  • Autoimmune Condition

The primary goal of treatment for polymyalgia rheumatica is relief of symptoms. For giant cell arteritis, the aim is to alleviate symptoms and to prevent vision loss and other potential complications.

Polymyalgia rheumatica and giant cell arteritis are primarily treated with:

  • Corticosteroids. These anti-inflammatory medications are a mainstay of treatment for both disorders. Doctors usually prescribe low to moderate doses, taken orally, for polymyalgia rheumatica and higher doses for giant cell arteritis. Most people respond to these medications within days to weeks, and once symptoms resolve, the dosage is usually gradually decreased. You may remain on a maintenance dose for a year or possibly longer. Because these are potent drugs, your doctor will prescribe the lowest dose possible to achieve the desired benefit. 

Other medications your doctor may prescribe include:

  • Disease-modifying antirheumatic drugs (DMARDs). These medications, approved for other conditions, are small molecules that act on inflammation at the cellular level. Doctors may prescribe them in combination with corticosteroids, especially in people who experience side effects from these medications, or to quell a flare of symptoms.
  • Biologic response modifiers. These medications, which are also DMARDs, target specific immune messages and interrupt the signal, helping to decrease or stop inflammation. They are sometimes prescribed in combination with corticosteroids in people with giant cell arteritis.

Osteoporosis, a condition characterized by weak and brittle bones, can be a complication of taking corticosteroids, so your doctor may also prescribe medications to strengthen the bones.

  • Who Treats Polymyalgia Rheumatica and Giant Cell Arteritis?
  • Autoimmune Condition

Polymyalgia rheumatica and giant cell arteritis are primarily treated by:

  • Rheumatologists specialize in treating arthritis and other diseases that affect the joints, bones, muscles, and immune system.
  • Primary care doctors, such as family physicians or internal medicine specialists.

Other health care providers who may be involved in your care include:

  • Ophthalmologists, in cases of giant cell arteritis, are involved when the eyes are affected. Ophthalmologists specialize in treating disorders and diseases of the eye.
  • Cardiologists or vascular surgeons, in cases of giant cell arteritis affecting the aorta and its main branches. These specialists focus on treating blood vessel problems.
  • Mental health professionals who help people cope with difficulties in the home and workplace that may result from their medical conditions.
  • Physical therapists are movement specialists who improve quality of life through prescribed exercise, hands-on care, and patient education.
  • Living With Polymyalgia Rheumatica and Giant Cell Arteritis
  • Autoimmune Condition

Corticosteroids can cause side effects, even at low doses, and it is important to let your doctor know if you experience any of them. The side effects include:

  • Heightened risk of infections.
  • Mood swings.
  • Insomnia.
  • High blood pressure.
  • Vision problems (such as cataracts or glaucoma).
  • Diabetes.
  • Osteoporosis (thinning, weakened bones).
  • Weight gain.
  • Swelling of the face, legs, or other parts of the body.
  • Loss of muscle.

If you notice signs of any of these adverse effects, your doctor may need to adjust the corticosteroid dose. Below are some tips to help you avoid side effects.

  • To protect your bones, make sure you get enough calcium and vitamin D and do weight-bearing exercises, such as walking.
  • To avoid weight gain and lower the risk of diabetes and high blood pressure, eat a healthy, balanced diet and exercise regularly.
  • If you smoke, see your doctor about making a plan to quit. Smoking can affect bone and heart health.

It is also important to:

  • Visit your health care providers regularly and follow their recommendations.
  • Talk to your doctor before beginning an exercise program. He or she may refer you to a physical therapist, who can develop a plan to help you be more active and manage pain.
  • Talk to a mental health professional or join a support group if you develop anxiety or depression. Living with polymyalgia rheumatica or giant cell arteritis may be challenging at times, and sharing your experiences with others may help.

Source:
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
Polymyalgia Rheumatica and Giant Cell Arteritis.
https://www.niams.nih.gov/health-topics/polymyalgia-rheumatica-giant-cell-arteritis

Diseases

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(951) 781-7700

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info@arthritismedicalclinic.org

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6180 Brockton Avenue, STE. #204
Riverside, CA 92506

4244 Riverwalk Parkway, STE. #220
Riverside, CA 92505

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  • Medical Disclaimer

This information is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider for diagnosis and treatment recommendations specific to your condition.