Polymyalgia rheumatica (PMR) is a disorder generally seen in people over age 50 that causes stiffness and aching in the neck, shoulder and hip areas. Other symptoms may include fatigue, weight loss, low grade fever and depression. These symptoms are due to an underlying inflammatory disorder.
Giant cell arteritis (GCA) is a condition in which certain arteries become inflamed. It is also called temporal arteritis, as it often affects the arteries near the temples, although it can involve arteries in just about any part of the body. The inflammation of the involved artery leads to narrowing and sometimes to complete blockage of the blood vessel. This results in the surrounding tissues being deprived of an adequate blood supply. When GCA involves the arteries that supply blood to the eyes, blindness in one or both eyes may develop suddenly. Strokes may rarely occur. Some of the more common symptoms in GCA include headaches, pain in the jaw or tongue muscles when eating or talking, and tenderness of the scalp over the temples.
GCA and PMR seem to be related, as they often occur together. Over 10 percent of people with PMR also have GCA; approximately 50 percent of people with GCA also have PMR.
The causes of PMR and GCA are not known. Because these are disorders that occur primarily in older people, it has been suggested that these diseases may be related somehow to the process of aging. A genetic predisposition seems to be involved.
PMR is a syndrome, and unfortunately, there are no specific tests. Other conditions that cause symptoms similar to PMR need to be excluded before the diagnosis of PMR can be confidently made. The diagnosis of PMR is made based on the history and physical examination along with blood tests. A biopsy of an affected blood vessel – usually the temporal artery – is necessary to confirm GCA.
The goal in treating PMR and GCA is to relieve the symptoms and, in the case of GCA, to prevent damage to the tissues. The most commonly used medication is prednisone. Usually patients with PMR respond very quickly to low doses; patients with GCA usually require larger doses of this medication. Treatment often extends for two years or longer. In mild cases of PMR, it may be possible to treat the symptoms with nonsteroidal anti-inflammatory medications. Corticosteroids and nonsteroidal anti-inflammatory drugs can have side effects which may be particularly severe in the elderly. Methotrexate may be used as an alternative to steroids.
PMR and GCA can have severe complications and be challenging to diagnose. The management of the medications required to control these diseases is not always straightforward. Rheumatologists are specialists whose training focuses on the diagnosis and management of disorders of the joints, muscles and connective tissue which includes diseases such as PMR and GCA.
