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Publication Date: February 2001
Questions and Answers About Polymyalgia Rheumatica and Giant Cell Arteritis
What Are Polymyalgia Rheumatica and Giant Cell Arteritis?
Polymyalgia rheumatica is a rheumatic disorder that is
associated with moderate to severe muscle pain and stiffness in the
neck, shoulder, and hip area. Stiffness is most noticeable in the morning.
This disorder may develop rapidly--in some patients, overnight. In other
people, polymyalgia rheumatica develops more gradually. The cause of
polymyalgia rheumatica is not known; however, possibilities include
immune system abnormalities and genetic factors. The fact that polymyalgia
rheumatica is rare in people under the age of 50 suggests it may be
linked to the aging process.
Polymyalgia rheumatica may go away without treatment in
1 to several years. With treatment, the symptoms of polymyalgia rheumatica
are quickly controlled, but relapse if treatment is stopped too early.
Giant cell arteritis, also known as temporal arteritis
and cranial arteritis, is a disorder that results in swelling of arteries
in the head (most often the temporal arteries, which are located on
the temples on each side of the head), neck, and arms. This swelling
causes the arteries to narrow, reducing blood flow. Early treatment
is critical for good prognosis.
How Are Polymyalgia Rheumatica and Giant Cell Arteritis
Related?
It is unclear how or why polymyalgia rheumatica and giant
cell arteritis are related, but an estimated 15 percent of people in
the United States with polymyalgia rheumatica also develop giant cell
arteritis. Patients can develop giant cell arteritis either at the same
time as polymyalgia rheumatica or after the polymyalgia symptoms disappear.
About half of the people affected by giant cell arteritis also have
polymyalgia rheumatica.
When a person is diagnosed with polymyalgia rheumatica,
the doctor also should look for symptoms of giant cell arteritis because
of the risk of blindness. With proper treatment, the disease is not
threatening. Untreated, however, giant cell arteritis can lead to serious
complications including permanent vision loss and stroke. Patients must
learn to recognize the signs of giant cell arteritis, because they can
develop even after the symptoms of polymyalgia rheumatica disappear.
Patients should report any symptoms to the doctor immediately.
Who Is at Risk?
White women over the age of 50 are most at risk of developing
polymyalgia rheumatica and giant cell arteritis. Women are twice as
likely as men to develop the conditions. Both conditions almost exclusively
affect people over the age of 50. The average age at onset is 70 years.
Polymyalgia rheumatica and giant cell arteritis are quite common. In
the United States, it is estimated that 700 per 100,000 people in the
general population over 50 years of age develop polymyalgia rheumatica.
An estimated 200 per 100,000 people over the age of 50 develop giant
cell arteritis.
What Are the Symptoms?
The primary symptoms of polymyalgia rheumatica are moderate
to severe stiffness and muscle pain near the neck, shoulders, or hips.
The stiffness is more severe upon waking or after a period of inactivity,
and typically lasts longer than 30 minutes. People with this condition
also may have flu-like symptoms, including fever, weakness, and weight
loss.
Early symptoms of giant cell arteritis also may resemble
the flu. People are likely to experience headaches, pain in the temples,
and blurred or double vision. Pain may also affect the jaw and tongue.
How Are Polymyalgia Rheumatica and Giant Cell Arteritis
Diagnosed?
No single test is available to definitively diagnose polymyalgia
rheumatica. To diagnose the condition, a physician considers the patient’s
medical history, including symptoms that the patient reports, and results
of laboratory tests that can rule out other possible diagnoses.
The most typical laboratory finding in people with polymyalgia
rheumatica is an elevated erythrocyte sedimentation rate, commonly referred
to as the sed rate. This test measures how quickly red blood cells fall
to the bottom of a test tube of unclotted blood. Rapidly descending
cells (an elevated sed rate) indicate inflammation in the body. While
the sed rate measurement is a helpful diagnostic tool, it alone does
not confirm polymyalgia rheumatica. An abnormal result indicates only
that tissue is inflamed, which also is a symptom of many forms of arthritis
and/ or other rheumatic diseases. Before making a diagnosis of polymyalgia
rheumatica, the doctor may perform additional tests to rule out other
conditions, including rheumatoid arthritis, because symptoms of polymyalgia
rheumatica and rheumatoid arthritis can be similar.
The doctor may recommend a test for rheumatoid factor
(RF). RF is an antibody sometimes found in the blood. (An antibody is
a special protein made by the immune system.) People with rheumatoid
arthritis are likely to have RF in their blood, but most people with
polymyalgia rheumatica do not. If the diagnosis still is unclear, a
physician may conduct additional tests to rule out other disorders.
Doctors and patients both need to be aware of the risk
of giant cell arteritis in people with polymyalgia rheumatica and should
be on the lookout for symptoms of the disorder. Severe headaches, jaw
pain, and vision problems are typical symptoms of giant cell arteritis.
In addition, physical examination may reveal an abnormal temporal artery:
tender to the touch, inflamed, and with reduced pulse. Because of the
possibility of permanent blindness, a temporal artery biopsy is recommended
if there is any suspicion of giant cell arteritis.
In a person with giant cell arteritis, the biopsy will
show abnormal cells in the artery walls. Some patients showing symptoms
of giant cell arteritis will have negative biopsy results. In such cases
the doctor may suggest a second biopsy.
What Are the Treatments?
Polymyalgia rheumatica usually disappears without treatment
in 1 to several years. With treatment, however, symptoms disappear quickly,
usually in 24 to 48 hours. If there is no improvement, the doctor is
likely to consider other possible diagnoses.
The treatment of choice is corticosteroid medication,
usually prednisone. Polymyalgia rheumatica responds to a low daily dose
of prednisone. The dose is increased as needed until symptoms disappear.
Once symptoms disappear, the doctor may gradually reduce the dosage
to determine the lowest amount needed to alleviate symptoms. The amount
of time that treatment is needed is different for each patient. Most
patients can discontinue medication after 6 months to 2 years. If symptoms
recur, prednisone treatment is required again.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
aspirin and ibuprofen also may be used to treat polymyalgia rheumatica.
The medication must be taken daily, and long-term use may cause stomach
irritation. For most patients, NSAIDs alone are not enough to relieve
symptoms.
Giant cell arteritis carries a small but definite risk
of blindness. The blindness is permanent once it happens. A high dose
of prednisone is needed to prevent blindness and should be started as
soon as possible, perhaps even before the diagnosis is confirmed with
a temporal artery biopsy. When treated, symptoms quickly disappear.
Typically, people with giant cell arteritis must continue taking a high
dose of prednisone for 1 month. Once symptoms disappear and the sed
rate is normal and there is no longer a risk of blindness, the doctor
can begin to gradually reduce the dose. When treated properly, giant
cell arteritis rarely recurs.
People taking low doses of prednisone rarely experience
side effects. Side effects are more common among people taking higher
doses. But all patients should be aware of potential effects, which
include:
-
fluid retention and weight gain
-
rounding of the face
-
delayed wound healing
-
bruising easily
-
diabetes
-
myopathy (muscle wasting)
-
glaucoma
-
increased blood pressure
-
decreased calcium absorption in the bones, which can
lead to osteoporosis
-
irritation of the stomach
People taking corticosteroids may have some side effects
or none at all. A patient should report any side effects to the doctor.
When the medication is stopped, the side effects disappear. Because
prednisone and other corticosteroid drugs change the body’s natural
production of corticosteroid hormones, the patient should not stop taking
the medication unless instructed by the doctor. The patient and doctor
must work together to gradually reduce the medication.
What Is the Outlook?
Most people with polymyalgia rheumatica and giant cell
arteritis lead productive, active lives. The duration of drug treatment
differs by patient. Once treatment is discontinued, polymyalgia may
recur; but once again, symptoms respond rapidly to prednisone. When
properly treated, giant cell arteritis rarely recurs.
What Research Is Being Conducted To Help People Who Have
Polymyalgia Rheumatica and Giant Cell Arteritis?
Researchers studying possible causes of polymyalgia rheumatica
and giant cell arteritis are investigating the role of genetic predisposition,
immune system abnormalities, and environmental factors. Scientists also
are looking for markers of the diseases, exploring treatments, and studying
why the two disorders often occur together.
With funding from the National Eye Institute, a new mouse
model of giant cell arteritis is being used to examine interactions
between the immune system and blood vessels to explain tissue damage.
Where Can People Get More Information About Polymyalgia
Rheumatica and Giant Cell Arteritis?
National Institute of Arthritis and Musculoskeletal
and Skin
Diseases Information Clearinghouse
NIAMS/National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or
877-22-NIAMS (226-4267) (free of charge)
TTY: 301-565-2966
Fax: 301-718-6366
www.niams.nih.gov
National Eye Institute Information Clearinghouse
2020 Vision Place
Bethesda, MD 20892-3655
Phone: 301-496-5248
Fax: 301-402-1065
www.nei.nih.gov
National Heart, Lung, and Blood Institute
31 Center Drive, MSC 2480
Bethesda, MD 20892-2480
Phone: 301-496-4236
Fax: 301-402-2405
www.nhlbi.nih.gov
American College of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345
Phone: 404-633-3777
Fax: 404-633-1870
www.rheumatology.org
Arthritis Foundation
1330 West Peachtree Street
Atlanta, GA 30309
Phone: 404-872-7100 or 800-283-7800 (free of charge)
or call your local chapter (listed in the telephone directory)
www.arthritis.org
Acknowledgements
The NIAMS gratefully acknowledges the assistance of Gene
G. Hunder, M.D., and Cornelia M. Weyland, M.D., of the Mayo Clinic,
and Louis A. Healey, M.D. (retired), in the preparation and review of
this booklet.
The mission of the National Institute of Arthritis
and Musculoskeletal and Skin Diseases (NIAMS), a part of the National
Institutes of Health (NIH), is to support research into the causes,
treatment, and prevention of arthritis and musculoskeletal and
skin diseases, the training of basic and clinical scientists to
carry out this research, and the dissemination of information
on the progress of research in these diseases. The National Institute
of Arthritis and Musculoskeletal and Skin Diseases Information
Clearinghouse is a public service sponsored by the NIAMS that
provides health information and information sources. Additional
information can be found on the NIAMS Web site at www.niams.nih.gov/.