Polymyalgia Rheumatica and Temporal Arteritis

Polymyalgia causes pain of the muscles of the shoulders, upper arms, buttocks thighs and calves.

This pain prevents the sufferer from raising their arms. There is difficulty or they may be unable to get out of a chair, to get out the car or to get off of the toilet.

  • Stiffness in the morning lasts for hours.
  • Frequently, this condition begins abruptly.
  • There may be a fever in the beginning.

“I was well until yesterday and I awakened with pain in my muscles that is so severe that I feel like I was beaten.”

  • People are frequently scared that they will no longer be able to be active.
  • Sometimes Polymyalgia begins after unusually strenuous exercise.
  • The beginning may be a flu-like illness that does not resolve.
  • Polymyalgia may be truly disabling before treatment.
  • A healthy person is reduced to inactivity because of pain and stiffness.
  • It is important to recognize Polymyalgia because treatment is so gratifying.
  • Pain and stiffness rapidly responds to treatment.

Often within a few days, the pain is gone; there is full shoulder motion; it is again easy to get up and move about..

Treatment consists of anti-inflammatory medications. Roughly half of the people with Polymyalgia will respond at least partially to an anti-inflammatory. Many Polymyalgia sufferers will need to take Prednisone. Most of the time, the relief from Prednisone is dramatic, beginning within the first two days of treatment. There is usually total relief with Prednisone. Certainly since Prednisone is a steroid, there is the potential to develop side effects. The dosage and duration of treatment should be closely monitored to minimize the amount and duration of medication used.

Approximately 10% of people with Polymyalgia Rheumatica will get Temporal Arteritis (also called Cranial Arteritis).

Arteritis means inflammation of the blood vessels (arteries). The areas of blood vessel involvement are the scalp, brain, jaw, eye and in the arteries supplying the arms. The condition is called Temporal Arteritis because the areas most commonly affected are the temples. When arteries become inflamed, the arteries become partially or totally blocked. Blockage of blood vessels in the scalp causes headache. If blood vessels in the jaw are blocked, there is pain with chewing. More seriously there may be stroke or loss of vision due to blockage of vessels in the brain or the eye.

It is important for the physician to immediately diagnose the condition so that treatment is begun and blindness or stroke prevented.

The treatment of Temporal Arteritis is Prednisone.

There are two laboratory tests, which help in making the diagnosis of Polymyalgia Rheumatica and Temporal Arteritis; these are the Erythrocyte Sedimentation Rate and the C-reactive protein. Both are measures of inflammation.

Occasionally these tests are normal in the presence of one of these diseases.

The cause of these two conditions is unknown.

The duration of these illnesses varies from days to years. Many people require medication for a two-year period to suppress symptoms. After that period of time, these conditions resolve. There may be recurrences, fortunately these recurrences respond quickly to treatment and do not last for very long.

A temporal artery biopsy may be performed. A positive test confirms the presence of inflammation in the temporal artery. If the biopsy is negative, it does not prove that the person does not have Temporal Arteritis. There may be tiny areas of inflammation in the arteries, which are not removed when the biopsy is performed. Areas of inflammation may also be missed when the artery is cut and prepared for viewing under the microscope.