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

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Catherine Burt Driver, MD
    Catherine Burt Driver, MD

    Catherine Burt Driver, MD

    Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

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Giant cell arteritis and polymyalgia rheumatica (PMR)

What are they?

Giant cell arteritis, also called temporal arteritis or cranial arteritis, is a serious disease that is characterized by inflammation of the walls of the blood vessels (vasculitis). The vessels affected are the arteries (hence the name "arteritis"). The diagnosis is confirmed with a biopsy of an artery, usually an artery on the side of the scalp called the temporal artery.

Polymyalgia rheumatica (PMR) is a disorder of the muscles and joints of older persons. It is characterized by pain and stiffness, affects both sides of the body, and involves the shoulders, arms, neck, and buttock areas.

Giant cell arteritis occurs in 10-15% of patients with polymyalgia rheumatica. The age of affected patients with these conditions is over 50 years. The onset of giant cell arteritis may be years before, after, or without accompanying polymyalgia rheumatica.

Polymyalgia rheumatica and giant cell arteritis facts

  • 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.

What is polymyalgia rheumatica?

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.

What causes polymyalgia rheumatica?

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.

What are symptoms and signs of polymyalgia rheumatica?

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.

How is polymyalgia rheumatica diagnosed?

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.

Medically Reviewed by a Doctor on 3/7/2016

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