Polymyalgia Rheumatica (PMR) &
Giant Cell Arteritis (Temporal Arteritis)

• Polymyalgia rheumatica causes pain and stiffness in muscles and joints.
• Polymyalgia rheumatica is diagnosed by characteristic symptoms associated with abnormal blood testing for inflammation.
• Polymyalgia rheumatica is treated with low doses of cortisone medications.
• Giant cell arteritis is a result of inflammation of arteries.
• Giant cell arteritis can lead to blindness and/or stroke.
• Giant cell arteritis is detected by a biopsy of an artery.
• Giant cell arteritis is treated with high-dose cortisone medications.

Polymyalgia rheumatica is a disorder of the muscles and joints characterized by muscle pain and stiffness, affecting both sides of the body, and involving the shoulders, arms, neck, and buttock areas. Patients with polymyalgia rheumatica are typically over 50 years of age. Polymyalgia rheumatica is abbreviated PMR.

Because both polymyalgia rheumatica and giant cell arteritis sometimes occur in the same patient, both diseases are reviewed here.

The cause of polymyalgia rheumatica is not known. Recent research has indicated that genetic (inherited) factors play a role in who becomes afflicted with the illness. Theories have included viral stimulation of the immune system in genetically susceptible individuals. Rarely, polymyalgia rheumatica is associated with a cancer. In this setting, the cancer may be initiating an inflammatory immune response to cause the polymyalgia rheumatica symptoms.

The onset of the illness can be sudden. A patient may have a healthy history until awakening one morning with stiffness and pain of muscles and joints throughout the body. These pains can lead to a sensation of weakness and loss of function. Sometimes there is also muscle tenderness. These symptoms persist and are often accompanied by an intense sensation of fatigue. Some patients notice a gradual loss of appetite, weight, and energy. Depression can occur.

The diagnosis of polymyalgia rheumatica is suggested by the history and physical examination. The doctor frequently notes muscle tenderness and that the motion of the shoulders is limited by pain. The joints are usually not swollen. However, swelling of the small joints of the hands, wrists, and/or knees can occur. Blood testing for inflammation is generally abnormal, as indicated by a significant elevation in the erythrocyte sedimentation rate (sed rate or ESR) and/or C-reactive protein. There are no specific tests, however, for polymyalgia rheumatica and X-rays are normal. The diagnosis is based on the characteristic history of persisting muscle and joint pain and stiffness associated with elevated blood tests for inflammation, such as the ESR. It is also not unusual for patients to have slight elevations of liver blood tests.