If your shoulders or neck are painful and stiff, polymyalgia rheumatica can be the cause. This is an inflammatory rheumatic disease that occurs primarily in people over 50 years of age. Which symptoms are typical and how the treatment is carried out!
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quick overview
Definition: Polymyalgia rheumatica, sometimes also called polymyalgia for short, is an inflammatory rheumatic disease. It mainly affects older people over the age of 50.
Symptoms: Muscle stiffness and symmetrical pain in different areas of the body, especially in the shoulders, upper arms or thighs.
Diagnosis: Determination of the blood cell sedimentation rate (ESR) and the C-reactive protein (CRP), imaging methods to rule out other diseases
Treatment: Polymyalgia rheumatica is mainly treated with cortisone.
Life expectancy: With appropriate therapy, people with PMR do not have an increased mortality rate compared to the general population.
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Polymyalgia rheumatica: what is it?
Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease characterized by severe, symmetrical muscle pain and stiffness, especially in the early morning hours. The term “polymalgia” means something like “multiple muscle pain”.
How common is PMR?
After rheumatoid arthritis, polymyalgia rheumatica is the second most common inflammatory rheumatic disease in old age. It occurs mostly in people over 50 years of age. In Germany, around 3 out of 100,000 residents fall ill every year. Women are affected more often than men.
Symptoms of polymyalgia rheumatica
Typical of polymyalgia rheumatica is usually sudden, severe, symmetrical pain in the shoulders or upper arms, more rarely in the pelvic girdle or thighs.
The pain is associated with stiffness and sometimes with muscle weakness. They occur mainly at night and in the early morning hours and increase with movement. Symptoms can be so severe that people have trouble getting dressed or brushing their teeth. If the pelvis and legs are more affected, it is difficult to stand up or climb stairs.
In addition, the following symptoms are possible with PMR:
Some of those affected also suffer from symptoms of giant cell arteritis (formerly: temporal arteritis). Characteristic of this are stabbing headaches in the temple areas and blurred vision. If left untreated, this condition can lead to blindness in a few days to weeks.
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Causes of polymyalgia rheumatica
The causes of polymyalgia rheumatica are not yet known. However, it is known that it is an autoimmune disease in which the immune system attacks the body’s own proteins.
The pain is caused by a combination of inflammation of the joints (arthritis), tendons (tenosynovitis) and ligament attachments (enthesitis).
Experts assume that several factors play a role:
- infectious triggers
- autoimmune processes
- environmental influences
- genetic predisposition
The disease tends to run in families. However, polymyalgia rheumatica is not one of the classic hereditary diseases.
Polymyalgia rheumatica: How to diagnose
The medical diagnosis of multiple muscle pain is based on a detailed survey. If the patents are over 50 years old and report pain in both shoulders or hips and pronounced morning stiffness, this suggests PMR.
In most cases, those affected are then referred to a rheumatologist, who usually arranges the following blood and urine tests:
ESR, since this laboratory value is usually elevated in polymyalgia rheumatica
C-reactive protein (CRP), a marker of inflammation in the blood
Hemoglobin concentration, to detect anemia (anemia)
Liver enzymes, particularly γ-GT, which are also elevated in PMR
In addition, imaging methods such as ultrasound, magnetic resonance imaging (MRI) or PET-CT are sometimes used to localize inflammation more precisely.
The attempt at therapy with cortisone is also of diagnostic importance. A good response to cortisone is an indication of the presence of polymyalgia rheumatica. The symptoms usually improve after a short time.
Differential diagnoses: diseases with similar symptoms
A challenge in the diagnosis is the differentiation from diseases with similar symptoms. This includes:
Giant cell arteritis (GCA): The disease is very similar to polymyalgia rheumatica and often occurs at the same time. Experts disagree as to whether these are two different diseases at all, or whether they are both consequences of the same disease process. GCA manifests itself in the form of headaches and jaw pain as well as visual disturbances and, if left untreated, can lead to blindness.
Rheumatoid arthritis: The joints of the fingers and toes are particularly affected. Especially in older people, the symptoms can resemble those of multiple muscle pain.
gout or pseudogout (chondrocalcinosis): These can also lead to pain in the knee or shoulder joint, but cause less stiffness and typically come in flares.
Fibromyalgia: The pain syndrome, also popularly known as soft tissue rheumatism, manifests itself as diffuse pain in the joints and muscles, which is similar to the symptoms of PMR. In contrast to PMR, however, the inflammatory values in the blood are not increased in fibromyalgia.
In people under the age of 50, other causes such as Lyme disease or a malignant tumor disease must also be considered if the inflammation values are elevated.
How is polymyalgia rheumatica treated?
Polymyalgia rheumatica is usually treated with cortisone. Symptoms often improve within a few hours.
The required dose of cortisone depends on whether it is an isolated polymyalgia rheumatica or whether giant cell arteritis is also present. The latter must be treated with higher doses, otherwise the inflammation of the arteries supplying the eyes can lead to blindness.
If the symptoms improve, the medication is slowly switched to lower doses. As a rule, the medication can be discontinued after about a year. In some cases, however, they must be taken at low doses for several years.
Good to know:
Long-term cortisone therapy can increase the risk of developing osteoporosis. Therefore, an additional intake of calcium and vitamin D may be necessary after medical consultation. A bone density measurement should also be carried out in order to identify and treat reduced bone density in good time.
Alternatives to cortisone are long-acting immunosuppressants such as methotrexate. Depending on the intensity of the inflammation, the therapy must be carried out consistently over a period of one to two years, but then in low doses. Since phases of the disease with active inflammation are possible again after phases without symptoms (remission), it is important to check the inflammation markers in the blood regularly.
Prognosis of polymyalgia rheumatica
With adequate treatment, the long-term prognosis is considered good. Around 50 to 70 percent of patients are symptom-free after completing therapy. In the rest, however, the symptoms can reappear after a short time (recurrence). With a short cortisone therapy, the risk of recurrence is slightly higher.
If you experience headaches, blurred vision, or other symptoms of giant cell arteritis, you should seek medical attention as soon as possible because the disease can quickly lead to blindness.
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