What Triggers Polymyalgia Rheumatica?

Symptoms of polymyalgia rheumatica include pain and stiffness in the shoulders, hips, and neck, usually on both sides of the body.

Polymyalgia rheumatica is a common chronic inflammatory condition that causes stiffness and aches in the shoulders, neck, and hips, and typically affects people aged 50 and older. 

Symptoms of polymyalgia rheumatica include pain and stiffness in the shoulders, hips, and neck, usually on both sides of the body. Characteristics of the pain and stiffness include:

• Stiffness may be severe and patients may have difficulty standing up from sitting, getting up from the toilet, turning over in bed, getting out of bed, or raising the arms above the shoulders
• Stiffness may occur after periods of rest (gel phenomenon)
• Morning stiffness for more than 1 hour is common
• Swelling of the arms or legs
• Swelling of peripheral joints
• Limited range of motion in the hips or shoulders

Other systemic symptoms include:

• Fever 
• Weight loss 
• Feeling unwell (Malaise)
• Fatigue
• Depression 
• Carpal tunnel syndrome
• High, intermittent spiking fevers (rare – see a doctor if this occurs) 
• Possible development of joint pain and muscle pain up to six months after systemic symptoms begin

The cause of polymyalgia rheumatica is unknown. It is thought there may be a genetic component since the condition is more common among northern Europeans.

It may also be due to an autoimmune process, and some researchers believe nonerosive synovitis and tenosynovitis may be responsible for several symptoms of polymyalgia rheumatica.

Other risk factors for polymyalgia rheumatica include: 

• Age of 50 years or older 
• The presence of giant cell arteritis 
• Use of cancer therapy with immune checkpoint inhibitors such as nivolumab (Opdivo) (a rare complication) 

Laboratory studies are performed to confirm a diagnosis of polymyalgia rheumatica, including:

• Rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies (anti-CCP) 
• C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR) 
• Complete blood cell count (CBC) with differential 
• Blood glucose 
• Serum creatinine 
• Liver function tests 
• Bone profile (including calcium and alkaline phosphatase) 
• Dipstick urinalysis 

Other studies that may be indicated include:

• Protein electrophoresis 
• Thyroid-stimulating hormone (TSH) 
• Creatine kinase 
• Vitamin D 

In some cases, certain testing may be done to specifically rule out other conditions, such as:

• Antinuclear antibodies (ANA) 
• Anti–cytoplasmic neutrophil antibodies (ANCA) 
• Tuberculosis tests 
• Chest X-rays
• Magnetic resonance imaging (MRI)
• Ultrasound
• Positron emission tomography (PET) scans

Polymyalgia rheumatica treatment is aimed at reducing stiffness and aches, and relieving symptoms of fatigue and fever. 

Medications used to treat polymyalgia rheumatica include:

• Corticosteroids such as prednisone are the first-line treatment for polymyalgia rheumatica to reduce inflammation and relieve stiffness and pain
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve), may be used to treat mild cases
• Other drugs such as methotrexate (Trexall) and tocilizumab (Actemra) may be used

Other aspects of polymyalgia rheumatica treatment include:

• Exercise to maintain joint flexibility, muscle strength, and function - low/no impact exercises such as walking, cycling, or swimming are often recommended
• Physical therapy
• Calcium and vitamin D supplementation for patients who are receiving corticosteroid therapy
• Rest and recovery time from exercise and daily activities

Polymyalgia rheumatica is usually self-limiting and often goes away within several months to 5 years and is not generally associated with serious complications. 

Complications of polymyalgia rheumatica may include: 

• Diminished quality of life if the condition is not treated
• Side effects and complications from long-term corticosteroid therapy
• Relapses in up to 25% of all treated patients
• Higher risk for giant cell arteritis (GCA) 
• Bilateral eye inflammation (episcleritis, scleritis, or anterior uveitis) that develops during steroid tapering (rare) 

Polymyalgia rheumatica is usually self-limited and lasts months to a few years. If the condition is diagnosed and treated promptly and appropriately, patients have a normal life expectancy.