Polymyalgia Rheumatica and Giant Cell Arthritis

Polymyalgia Rheumatica (PMR) is a rheumatic disorder of the joints and connective tissue characterized by muscle pain and stiffness in the shoulders, neck and hip areas.

Giant cell arteritis, also called temporal arteritis, is a condition that results in inflammation of the arteries of the scalp, neck and can also extent to major blood vessels originating from heart called aorta and its branches to arms. It often starts off with flu like symptoms and is characterized by headaches, pain and tenderness over the temples. Giant Cell Arteritis is a far more serious disease than Polymyalgia Rheumatica because it can cause heart attack, stroke and permanent blindness.

These two conditions are related as they frequently occur together, either at the same time or following resolution of symptoms of one of the disorders.

Causes and symptoms

The most common symptoms of polymyalgia rheumatica are muscle pain and stiffness in the neck, shoulders and hips. This is usually most noticeable in the morning and may occur after a period of inactivity. Other general symptoms include fever, weakness, anemia and weight loss.

People with giant cell arteritis usually start off with flu like symptoms such as fatigue, fever, and loss of appetite. Other symptoms that occur can include headache, pain and tenderness over the temples, double vision, dizziness or problems with coordination and balance. Giant cell arteritis may also cause pain in the jaw or tongue when you chew or open your mouth wide. Ulceration of the scalp occurs in rare cases.

The cause of both polymyalgia rheumatica and giant cell arteritis is not known. However, genetic predisposition, immune system problems and environmental factors seem to play an important role in development of these disorders.

Diagnosis

The diagnosis of polymyalgia rheumatica and giant cell arteritis is based on your medical history, physical examination and symptoms. Your doctor may suggest blood tests such as an erythrocyte sedimentation rate and C-reactive protein test to measure for inflammation in the body. Since the presence of inflammation could be due to other rheumatic diseases or arthritis, a rheumatoid factor test is also ordered to rule out rheumatoid arthritis. A negative rheumatoid factor test suggests a diagnosis of polymyalgia rheumatica.

Diagnosis of giant cell arteritis begins with a physical examination. If the temporal artery is tender to touch and has reduced pulse, this indicates an inflamed temporal artery that may be due to giant cell arteritis. The diagnosis is confirmed by temporal artery biopsy.

Treatment

There is no cure for polymyalgia rheumatica, but symptoms can be easily managed and controlled with medications.

Giant cell arteritis is a far more serious disease than polymyalgia rheumatica which if not treated promptly carries a small but definite risk of blindness. Therefore, treatment for giant cell arteritis is started as soon as it is suspected even before it is confirmed by the temporal artery biopsy.

Corticosteroids are the drug of choice for the treatment of both polymyalgia rheumatica and giant cell arteritis. The symptoms usually go away in 6 months to two years with treatment. Medication is then gradually reduced and stopped. The condition may reappear however and require medication again.

It is very important to note that corticosteroids should be taken strictly as advised by the doctor and should never be stopped abruptly as complications can occur. Your doctor will gradually decrease the medicine based on your test results and symptoms.

Polymyalgia rheumatica and giant cell arteritis are common, closely related inflammatory conditions that often occur together or one after the other. With careful monitoring and appropriate treatment, most people with polymyalgia rheumatica and giant cell arteritis can lead a normal active life.

Your doctor may also advice you on diet and supplements to reduce inflammation and avoid adverse effects of steroids.