Polymyalgia rheumatica

Definition

Polymyalgia rheumatica is a disorder involving pain and stiffness in the hip or shoulder area.

Causes, incidence, and risk factors

Polymyalgia rheumatica is a disorder that almost always occurs in persons over 50 years old. The cause is unknown. Although symptoms are located predominantly in the muscles and there are no outward signs of arthritis, in some cases there is evidence of inflammatory arthritis.

The disorder may occur independently, or it may coexist with or precede temporal arteritis, which is an inflammation of blood vessels (usually in the head).

Symptoms

• Hip pain and stiffness
• Shoulder pain and stiffness
• Neck pain and stiffness
• Muscle pain (minimal, less common than aching)
• Fever
• Unintentional weight loss
• Anemia (low number of red blood cells in the blood)
• Fatigue (excessive tiredness)
• Malaise (general ill feeling)
• Face pain
• Other joint pain

Signs and tests

Fever may be the only symptom in some cases (the person has a fever of unknown origin). Signs of temporal arteritis may also be present.

Blood tests are nonspecific.

• The sedimentation rate (ESR ) is often elevated.
• Creatine kinase (CPK ) is normal.
• Hemoglobin or hematocrit may be normal or low.

Treatment

The goal of treatment is relief of discomfort and stiffness. The disease can be very bothersome if it is not treated. Corticosteroids, such as prednisone, are prescribed in low doses.

Expectations (prognosis)

Polymyalgia rheumatica usually resolves by itself, even when not treated, in 1 to 4 years. Symptoms diminish greatly with treatment. Most patients need steroid treatment for one or more years.

Complications

Polymyalgia rheumatica may precede giant cell arteritis or other disorders.

Calling your health care provider

Call for an appointment with your health care provider if you experience persistent weakness or stiffness of the pelvis or shoulder, especially if this is accompanied by symptoms of general illness, such as fever or headache.

Prevention

There is no known prevention.

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