Polymyalgia Rheumatica
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In PMR, the immune system causes the tissues of the joints to become inflamed, causing symptoms of muscle pain and stiffness
In GCA, the immune system makes the arteries inflamed, causing a range of symptoms including:
Many experts believe that rather than being two separate conditions PMR and GCA are symptoms of a single, as yet unidentified, underlying health condition. This is because cases of PMR and GCA often develop at the same time in one person.
An estimated 40-60% of people with GCA will also have, or will develop, PMR. An estimated 15-20% of people with PMR will also have, or will develop, GCA.
The causes of both PMR and GCA are unknown. As with many autoimmune conditions (conditions where the immune system attacks healthy tissue), it is thought that a combination of genetic and environmental factors is responsible.
PMR is uncommon.
PMR is age-related. Almost all cases develop in adults who are 50 or over. The older a person gets, the higher their risk of developing PMR.
PMR is three times as common in women as in men. It is most common among white people, particularly those of Scandinavian descent.
GCA is slightly less common than PMR, with an estimated seven new cases a year for every 100,000 people. GCA has the same risk factors as PMR, including age, ethnic group, sex and geographical location.
The outlook for people with PMR is excellent. It responds very well to steroid medication and most people will notice a significant improvement in symptoms within a few days of treatment. To prevent a relapse, though, it is usually necessary to take steroid medication for up to two years.
The outlook for GCA depends on whether the condition is diagnosed and treated with steroids before loss of vision occurs. If it is, GCA will usually respond well to treatment and people with GCA are unlikely to have any serious after-effects.
If GCA isn't treated with steroids before any vision is lost, it is likely that the loss will be permanent.
Muscle pain and stiffness are the most common symptoms of PMR. The pain and stiffness can range from moderate to severe.
In PMR, the muscles in the neck and shoulder are usually affected, although some people also experience pain and stiffness in their lower back, hips and thighs. You may also experience tenderness and pain in your upper arms.
The stiffness can be worse after waking up. This stiffness will usually only last for 30 to 60 minutes, and will improve when you become active. The pain may be more persistent.
An estimated 40% of people with PMR will have additional symptoms, including:
Giant cell arteritis (GCA) can cause a wide range of symptoms. Most people who have GCA will not have all the symptoms.
The most common symptom of GCA is a headache that doesn't go away (a continuous headache). The pain is usually around the temple or the eyes. Painkillers, for example paracetamol, are usually not effective in treating the pain. Many people with GCA have described the headache as unlike any type of headache they have experienced before.
Other common symptoms of GCA include:
An estimated 50% of people with GCA will have pain in their jaw when chewing food.
About 20% of people with GCA experience loss of vision. Usually, only one eye is affected. People with GCA have described their vision loss as like having a shade placed over their eye. If it's not treated, vision can be lost in the other eye within one to two weeks.
You should see your GP as soon as possible if you have a continuous headache. A ‘normal’ headache will usually resolve within four hours, so a headache that lasts longer than four hours should be regarded as continuous.
It is particularly important that you seek immediate medical advice if you have a continuous headache and you do not have a history of having continuous headaches. Visit your GP or telephone NHS 24 on 08454 24 24 24.
Symptoms of muscle pain and stiffness that persist for longer than two to three days also require investigation. If you experience periods of muscle stiffness, make an appointment to see your GP.
In PMR, the immune system sends infection-fighting white blood cells to attack the linings of your joints. This causes your joints to become inflamed (swollen), leading to symptoms of muscle pain and stiffness.
In cases of GCA, the immune system sends infection-fighting white blood cells to attack the lining of the large blood vessels (arteries) in your body causing them to swell.
In GCA, the temporal arteries are usually affected the most. The temporal arteries run through your neck and along the side of your head, supplying blood to the optic nerve.
The optic nerve is responsible for relaying information from your eyes to your brain. If the temporal artery becomes swollen, the optic nerve will lose its blood supply, causing it to fail and leading to vision loss.
It is not known what causes the immune system to suddenly malfunction and start attacking healthy tissue.
The fact that PMR and GCA tend to predominantly affect white people and are very rare in other ethnic groups suggests that genetics plays a role in the development of both conditions.
The fact that PMR and GCA are more widespread in certain geographical regions than others (even when both regions contain roughly the same ethnic make-up) suggests that there is environmental factor involved in the development of both conditions.
No specific genes or environmental factors have been identified in causing PMR and GCA.
As many of the symptoms of polymyalgia rheumatica (PMR) are the same as other health conditions, such as arthritis, health professionals use a checklist to help them to diagnose the condition.
There are a number of different checklists, but the most widely used one is known as the Bird criteria. Research has shown that the Bird criteria is the most effective checklist for diagnosing PMR.
According to the Bird criteria, a diagnosis of PMR can be made if you have three or more of the following:
The ESR test is used to determine how quickly it takes for red blood cells to settle when they are placed in a test tube. If they settle faster than normal, it usually means that your immune system is causing inflammation inside your body.
Your GP can make an initial diagnosis of giant cell arteritis (GCA) by asking you about your symptoms and carrying out a physical examination.
The swelling in your temporal arteries can often cause them to become visibly thickened.
Your GP may check the pulse in the affected arteries, because the swelling can sometimes alter the normal pattern of blood flow. They may carry out a physical examination of your scalp, as many people with GCA develop tender spots around their temples and eyes.
Further testing is then required in order to confirm the diagnosis. The first test is an ESR test to check for raised levels of inflammation inside your body.
The ESR test is followed by a test known as a temporal artery biopsy. During a temporal artery biopsy, a local anaesthetic is used to numb a part of your scalp. An incision (cut) is made in your scalp and a small piece of tissue is removed from the artery. Then the incision is sealed with stitches. The stitches in the scalp are removed after a few days.
The removed tissue will be studied under a microscope to check for any inflammation and cell damage. The biopsy is entirely painless and will leave little, if any, scarring.
The risk of vision loss that is associated with GCA means treatment with steroid medication is usually started immediately rather than waiting until the results of the tests are known.
Prednisolone works by reducing inflammation in the body. It is available in tablet form and most people will be prescribed one tablet once a day.
It is likely that you will be given high-dose prednisolone tablets at the beginning of your treatment and that the dosage will then be gradually reduced each month. You may be required to take prednisolone for up to two years in order to prevent symptoms returning.
You should have a marked improvement in symptoms within a few days of starting treatment.
Never stop taking your steroid medicines unless you are told by your GP that it is safe to do so. Suddenly stopping treatment with steroids can make you feel very ill.
About 5% of people who take prednisolone will have changes in their mental state when they take it. These changes may include:
If you experience any of the above, contact your GP as soon as possible.
Prednisolone will make you more vulnerable to infection, particularly the viruses that cause:
You may become very ill if you develop these viral infections, even if you have been previously infected.
Avoid close contact with anyone who has a chickenpox, shingles or measles infection. Seek immediate medical advice if you think you have been exposed to an infection that causes chickenpox, shingles or measles, or if a member of your household develops one of these infections.
Other side effects of prednisolone include:
These side effects should improve as your dosage of prednisolone is decreased.
Osteoporosis usually requires additional treatment (particularly if you're over 60) in order to prevent fracturing or breaking any bones. See Useful links for more information about treatment for osteoporosis.
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