Topic Overview
What are polymyalgia rheumatica and giant cell arteritis?
Polymyalgia rheumatica and giant cell arteritis are
inflammatory problems.
In polymyalgia
rheumatica (say "paw-lee-my-AL-juh roo-MAT-ih-kuh"), the
joints and the areas around them get stiff and may
ache. It mostly happens in the neck, shoulders, and hip.
In giant
cell arteritis (say "ar-tuh-RY-tus"), inflammation occurs in the
blood vessels that carry blood up through the neck to the head. It mostly
affects the arteries that carry blood to the eyes, temple, and jaw. Giant cell arteritis is also called temporal arteritis.
Polymyalgia rheumatica and giant cell arteritis can occur at the same
time and affect the same groups of people. Experts believe that the two
problems are linked.
Polymyalgia rheumatica is more common, but giant cell
arteritis is more dangerous because it can cause loss of vision and may lead to
a
stroke or mini-strokes. People who have giant cell arteritis need
treatment right away.
What causes polymyalgia rheumatica and giant cell arteritis?
Experts don't fully understand the cause of these
conditions. It may be that the body's defense system (immune system)
is attacking the body’s own tissues. Your
genes may play a role in this. For example, people
whose ancestors are from Scandinavia or Northern Europe are more likely to have
these problems.
What are the symptoms?
Symptoms of polymyalgia rheumatica often start suddenly and get worse without
treatment. The problem can cause:
- Muscle pain and morning stiffness in the
neck, shoulders, and hip area.
- Tiredness and lack of
energy.
- A low fever.
- Weight loss.
Symptoms of giant cell arteritis
can start either suddenly or slowly. This problem needs treatment right away,
because it can cause blindness, a stroke, or mini-strokes. Symptoms include:
- Vision problems.
- A severe
headache, often near the temple or around the eye.
- Tenderness of
the temple or scalp.
- Pain or aching of the tongue or jaw.
How are polymyalgia rheumatica and giant cell arteritis diagnosed?
Your doctor will do a physical exam and ask you about
your symptoms and past health. He or she may suggest blood tests to find out if
you have the conditions. Your doctor will have to rule out
arthritis, because the symptoms are similar. To see if
you have giant cell arteritis, a surgeon may take a sample (biopsy) from a blood vessel on your temple and test it
for inflammation.
How are they treated?
Your doctor will give you
steroid medicines to treat the inflammation. Most of
the time, symptoms improve quickly and go away 2 to 4 weeks after treatment
begins. After this, most people need to continue to take steroid medicines for
1 to 2 years or sometimes longer. This helps to control symptoms and to prevent
the problems from coming back.
Steroid medicines can cause your
bones to thin (osteoporosis).
Calcium is important for keeping your bones strong. So
you need to make sure you are getting enough calcium, enough vitamin D, and
enough weight-bearing exercise to strengthen your bones. Your doctor may also
give you a medicine to prevent bone thinning.
Who gets polymyalgia rheumatica and giant cell arteritis?
These problems most often occur after the age of 50,
and the risk increases after that as you get older.
Frequently Asked Questions
Learning about polymyalgia rheumatica and giant cell arteritis: | |
Being diagnosed: | |
Getting treatment: | |
Symptoms
Polymyalgia rheumatica
Symptoms of
polymyalgia rheumatica (PMR) often occur suddenly and
get worse without treatment. Typical polymyalgia rheumatica symptoms
include pain and morning stiffness in the:
- Shoulder.
- Neck.
- Pelvic and hip
region.
These symptoms are caused by
inflammation of joints,
tendons, and
bursae of the hip and shoulder regions. The pain
affects both sides of the body. For example, both shoulders will usually be
painful, not just one. Usually, both the shoulder and hip areas are
affected.
Other symptoms of polymyalgia rheumatica may
include:
- Feeling tired and having no energy or
strength (fatigue).
- Weight loss.
- Low
fever.
- Depression.
- Swelling of the
knees, wrists, or ankles.
Giant cell arteritis
Symptoms of
giant cell arteritis (GCA) can develop gradually or
suddenly. They require immediate treatment.
Symptoms of giant
cell arteritis may include:
- Headache, often near the temple or around the
eye (temporal headache). Headaches are a symptom for most people who are
examined for giant cell arteritis. The headache may begin as a dull, throbbing
pain on one side of the head around the eye or near the temple. Sometimes the
pain may feel like a stabbing or burning sensation.
- Vision
problems. These problems may come on quickly and be temporary, but
sometimes they do not go away. Examples include:
- Brief loss of vision or partial loss,
lasting seconds to minutes.
- Blurry or double
vision.
- Blindness.
- Patches of poor vision surrounded by
normal vision.
- Decreased sharpness (acuity) of vision or
focus.
- Tenderness on the side of the head (temple)
or scalp. The
blood vessel on the temple may also look swollen and its pulse may be
decreased or absent. You may notice tenderness when you wear your glasses or
comb your hair.
- Pain, aching, weakness, or cramping (claudication)
of the tongue or jaw, especially when you chew food or talk for long periods of
time.
Other uncommon symptoms of giant cell arteritis may
include cough, hoarseness, chest pain, and arm weakness or cramps.
Some people with giant cell arteritis do not have the typical symptoms of
headache, jaw pain, and vision problems. About half of people with giant cell
arteritis will also have symptoms of polymyalgia rheumatica.1
Untreated giant cell arteritis can cause
narrowing (constriction) of some of the
arteries in the skull or head, reducing blood flow. As a result, a person with
untreated giant cell arteritis is at greater risk of blindness,
stroke, or mini-strokes (transient ischemic attacks, or TIAs).
Conditions with symptoms similar to
polymyalgia rheumatica or giant cell arteritis include
osteoarthritis,
rheumatoid arthritis,
fibromyalgia, and
lupus.
Exams and Tests
To diagnose
polymyalgia rheumatica (PMR) and
giant cell arteritis (GCA), your doctor will do a
physical exam and ask you about your past health and symptoms. Because the two
conditions often occur together, it is important that your doctor determine
which one is causing your symptoms. Giant cell arteritis can be serious and
needs immediate treatment with higher doses of medicine than polymyalgia
rheumatica does.
Age is an important factor in making the
diagnosis, because these conditions rarely occur in people younger than 50. A
limited range of motion in the arms may be a sign of polymyalgia rheumatica,
and arteries on the temple or forehead that are swollen,
lumpy feeling, or tender may be a sign of giant cell arteritis.
Tests that can help diagnose polymyalgia rheumatica and giant cell
arteritis include:
- Erythrocyte sedimentation rate (ESR). This test measures how quickly red blood cells
(erythrocytes) settle in a test tube in 1 hour. A high ESR may be a sign of
polymyalgia rheumatica or giant cell arteritis.
- Complete blood count (CBC). People with either
polymyalgia rheumatica or giant cell arteritis often have mild
anemia. A CBC can show this.
- C-reactive protein. This test measures the amount of
C-reactive protein (CRP) produced when you have
inflammation somewhere in your body. Both giant cell
arteritis and polymyalgia rheumatica can cause a high CRP level.
- Temporal artery biopsy. When your doctor suspects
giant cell arteritis, this test can confirm the condition. In this biopsy, a
surgeon will take a sample of a blood vessel on your temple and test it for
inflammation.
- Ultrasound. In some cases, ultrasound of the arteries
on the side of the face near the temple (temporal arteries) may help diagnose
giant cell arteritis. This way of using ultrasound is still being studied for
use in the United States.
Your doctor may confirm a diagnosis of polymyalgia
rheumatica with a trial of
corticosteroid medicine. If you have polymyalgia
rheumatica, you are very likely to have great relief of symptoms within 2 to 4
days of starting treatment.
Tests that may be done to be sure
another condition is not causing your symptoms
include:
Treatment Overview
Corticosteroid medicine is the most
common treatment for both
polymyalgia rheumatica (PMR) and
giant cell arteritis (GCA). People with either or both
conditions usually have fast relief of their symptoms soon after starting
corticosteroid treatment.
Initial treatment
Corticosteroid medicine treats both
polymyalgia rheumatica (PMR) and
giant cell arteritis (GCA). In general, you will use
the corticosteroids at a certain dose until your symptoms go away and your lab
tests are normal. When this occurs, your doctor will gradually begin reducing
your medicine.
For polymyalgia rheumatica:
- You take lower doses of corticosteroids than
for giant cell arteritis.
- You are likely to have a lot of pain
relief in a few days. Symptoms usually go away, and your lab results are normal
in 2 to 3 weeks. If your symptoms don't start going away in 2 to 4 days,
your doctor may give you a higher dose and do further testing to be sure your
condition is polymyalgia rheumatica.
- After your symptoms go away
and your laboratory tests are normal, your doctor will gradually lower your
dose, about every few weeks to months.
- You will probably have to take
corticosteroids for about 2 years or more to prevent the symptoms from
returning (relapse). Some people only need to take the medicine
for less than a year.
For giant cell arteritis:
- You take higher doses of corticosteroids than
used in polymyalgia rheumatica.
- Because giant cell arteritis can
cause serious complications, such as
stroke or blindness, your doctor may start treatment
immediately, even if the diagnosis has not been confirmed by
tests.
- You are likely to have a lot of pain relief in a few days.
Symptoms usually go away, and your lab results are normal in 2 to 4 weeks. If
your symptoms don't start to go away, your doctor may give you a higher dose.
- After your symptoms go away and your lab tests are normal, your
doctor will gradually lower your dose, about every 2 to 4 weeks in the first
several months, then less often after that.
- You will probably have
to take corticosteroids for 1 to 2 years to prevent relapse, although many people with the condition need them for longer than 2
years.
See a table
comparing corticosteroid treatment of polymyalgia rheumatica and giant cell arteritis.
How long you need to take
corticosteroids depends on how severe your condition is, whether it appears
cured or not (remission), and how often you have
relapses. Some people are not able to completely stop
taking corticosteroids. If this happens, your doctor may suggest another
medicine such as methotrexate to help control your symptoms and keep the
condition from coming back.
Ongoing treatment
After your symptoms have gone
away and your laboratory tests are normal, ongoing treatment for
polymyalgia rheumatica (PMR) and
giant cell arteritis (GCA) usually includes continued
use of
corticosteroid medicine.
Your doctor
gradually lowers the amount of medicine you take. How quickly he or she does
this varies with the individual.
- In polymyalgia rheumatica, most people have to take corticosteroids for about 2
years.
- In giant cell arteritis, most people
have to take corticosteroids for 1 to 2 years, although many
people with the condition need them for longer than 2 years.
If your symptoms do not improve with corticosteroid
medicine, your doctor may need to test you for
other conditions that are similar to polymyalgia rheumatica or giant cell
arteritis.
Your doctor will track your condition while you are
taking corticosteroid medicine and for 6 to 12 months after you stop taking the
medicine. This tracking may include regular appointments or telephone calls to
discuss your symptoms and tests to measure your
erythrocyte sedimentation rate (ESR) or your
C-reactive protein (CRP) value.
See a
table comparing corticosteroid treatment of polymyalgia rheumatica and giant cell arteritis.
If you need long-term
corticosteroid treatment for either condition, you are at risk for bone
thinning (osteoporosis). This is because corticosteroids
decrease how well your body takes in calcium, which is important in building
strong bones. Your doctor may recommend a bone density (DEXA) test to
see if you need medicine (bisphosphonates) to prevent osteoporosis. Or he or
she may simply start you on bisphosphonates without the test. For more
information, see the topic
Osteoporosis.
Treatment if the conditions get worse
In both
polymyalgia rheumatica (PMR) and
giant cell arteritis (GCA), your symptoms may return
(relapse) after a period of improvement. This often
occurs in the first 2 years of treatment or during the first 12 months
after you stop taking corticosteroid medicine. A relapse usually occurs if the
dose of corticosteroids is reduced or withdrawn too quickly. But up to 50% of
people with either condition have a relapse over the first 2 years that is not
related to how corticosteroids are used.2 If you have
a relapse of symptoms, your doctor will increase the corticosteroid dosage for
a period of time, then gradually decrease it after your symptoms are
gone.
See a table
comparing corticosteroid treatment of polymyalgia rheumatica and giant cell arteritis.
In rare cases, giant cell
arteritis can affect the main part of the
aorta in the chest, rather than one of its smaller
branches, causing an
aortic aneurysm. If this were to happen, you would
feel severe chest pain that could extend to your back, and you could faint or
have symptoms of a
stroke. If you have giant cell arteritis and have such
symptoms, contact your doctor or call 911 immediately. Though rare,
such an event may be life-threatening. Your doctor may recommend that you have
an annual chest X-ray to watch for an aortic aneurysm.
Giant cell arteritis can lead to partial or complete loss of vision in one or both
eyes. If you have sudden onset of double, blurred, or
"browned-out" vision, or temporary loss of vision, your doctor may increase
your corticosteroid dose. And for a few days he or she may give you the dose
directly into a blood vessel (intravenously) to try to prevent
permanent or further loss of vision.
What to think about
If you have polymyalgia rheumatica and do not have giant cell arteritis,
your doctor may suggest using
nonsteroidal anti-inflammatory drugs (NSAIDs) when you
are lowering the dose of your corticosteroid medicine. Always talk to your
doctor or nurse before using these medicines.
Some doctors
recommend taking
aspirin if you have giant cell arteritis. This is
because some studies show that doing so may reduce the risk of vision loss,
stroke, or
transient ischemic attacks (blood flow to the brain is
interrupted).3
Corticosteroids can cause
serious side effects, including
high blood pressure (hypertension) and bone thinning
(osteoporosis). If you are taking long-term
corticosteroids to treat polymyalgia rheumatica or giant cell arteritis:
- You will need to get enough calcium and vitamin D.
- You may also need
bisphosphonate medicine such as alendronate or
risedronate to prevent bone loss.
- You can help reduce the risk of
osteoporosis by lifting weights and doing weight-bearing exercise such as
walking. For more information, see the topic
Osteoporosis.
- Your doctor may suggest
that you take a proton pump inhibitor such as Prilosec or a medicine called an
H2 blocker (acid reducer) to protect your digestive (gastrointestinal or GI)
tract, including your
esophagus and stomach. Taking a lot of medicine for a
long period of time can irritate these areas and can even lead to
ulcers. Proton pump inhibitors and H2 blockers
decrease the amount of acid the stomach makes. This reduces irritation of the
stomach and can help reduce irritation of the esophagus.
Methotrexate, or other medicines that suppress your
immune system, may be used for polymyalgia rheumatica
or giant cell arteritis alone or with corticosteroids to reduce the
corticosteroid dose and limit its side effects. Research results are mixed on
how effective this treatment is.4
Giant
cell arteritis sometimes affects the large arteries of the arm. In rare cases,
this interferes with blood flow. This can cause pain and cramping when you use
your arm. In a small study, balloon
angioplasty opened up the arteries of the arm to
decrease symptoms of giant cell arteritis.5
Home Treatment
To feel your best during treatment for
polymyalgia rheumatica (PMR) or
giant cell arteritis (GCA):
- Take your medicine as prescribed by your
doctor.
- Work closely with your doctor and nurse, reporting any
medicine side effects or symptoms of giant cell arteritis, such as headache,
jaw pain, and vision problems.
- Eat a balanced diet.
- Stop smoking, and avoid being around tobacco
smoke.
- Reduce how much alcohol you drink. It's a good idea to have
no more than one beer or one glass of wine each day.
- Be sure you get enough calcium and vitamin D to help prevent bone thinning (osteoporosis) if you are taking corticosteroids.
- Get mild, regular weight-bearing exercise, which
will help keep your bones strong and bolster your physical and emotional
ability to handle your illness.
If any of your symptoms get worse or come back, contact
your doctor or nurse.
Other Places To Get Help
Organizations
| National Institute of Neurological Disorders and
Stroke |
| NIH Neurological Institute |
| P.O. Box 5801 |
| Bethesda, MD 20824 |
| Phone: | 1-800-352-9424 |
| Phone: | (301) 496-5751 |
| TDD: | (301) 468-5981 |
| Web Address: | www.ninds.nih.gov |
| |
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders. |
|
| American College of Rheumatology |
| 2200 Lake Boulevard NE |
| Atlanta, GA 30319 |
| Phone: | (404) 633-3777 |
| Fax: | (404) 633-1870 |
| Web Address: | www.rheumatology.org |
| |
The American College of Rheumatology (ACR) and the
Association of Rheumatology Health Professionals (ARHP, a division of ACR) are
professional organizations of rheumatologists and associated health
professionals who are dedicated to healing, preventing disability from, and
curing the many types of arthritis and related disabling and sometimes fatal
disorders of the joints, muscles, and bones. Members of the ACR are physicians;
members of the ARHP include research scientists, nurses, physical and
occupational therapists, psychologists, and social workers. Both the ACR and
the ARHP provide professional education for their members. The ACR
website offers patient information fact sheets about rheumatic diseases, about
medicines used to treat rheumatic diseases, and about care
professionals. |
|
| National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), National Institutes of Health |
| 1 AMS Circle |
| Bethesda, MD 20892-3675 |
| Phone: | 1-877-22-NIAMS (1-877-226-4267) toll-free |
| Phone: | (301) 495-4484 |
| Fax: | (301) 718-6366 |
| TDD: | (301) 565-2966 |
| Email: | niamsinfo@mail.nih.gov |
| Web Address: | www.niams.nih.gov |
| |
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research. The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases. |
|
References
Citations
- Hellmann DB, Imboden JB Jr (2010). Polymyalgia rheumatica and giant cell arteritis section of Musculoskeletal and immunologic disorders. In SJ McPhee, MA Papadakis, eds., Current Medical Diagnosis and Treatment, 49th ed., pp. 766–767. New York: McGraw-Hill.
- Salvarani C, et al. (2002). Polymyalgia rheumatica and
giant-cell arteritis. New England Journal of Medicine,
347(4): 261–271.
- Nesher G, et al. (2004). Low-dose aspirin and
prevention of cranial ischemic complications in giant cell arteritis.
Arthritis and Rheumatism, 50(4): 1332–1337.
- Hellmann DB (2009). Giant cell arteritis, polymyalgia
rheumatica, and Takayasu's arteritis. In GS Firestein et al., eds.,
Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp.
1409–1428. Philadelphia: Saunders Elsevier.
- Both M, et al. (2006). Balloon angioplasty of arteries
of the upper extremities in patients with extracranial giant-cell arteritis.
Annals of the Rheumatic Diseases, 65(9):
1124–1130.
Other Works Consulted
- Hellmann DB (2009). Giant cell arteritis, polymyalgia
rheumatica, and Takayasu's arteritis. In GS Firestein et al., eds.,
Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp.
1409–1428. Philadelphia: Saunders Elsevier.
- Weyand CM, Goronzy JJ (2005). Polymyalgia rheumatica
and giant cell arteritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology,
15th ed., vol. 2, pp. 1777–1792. Philadelphia: Lippincott Williams and
Wilkins.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Anne C. Poinier, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | Stanford M. Shoor, MD - Rheumatology |
|---|
| Last Revised | April 13, 2011 |
|---|
Hellmann DB, Imboden JB Jr (2010). Polymyalgia rheumatica and giant cell arteritis section of Musculoskeletal and immunologic disorders. In SJ McPhee, MA Papadakis, eds., Current Medical Diagnosis and Treatment, 49th ed., pp. 766–767. New York: McGraw-Hill.
Salvarani C, et al. (2002). Polymyalgia rheumatica and
giant-cell arteritis. New England Journal of Medicine,
347(4): 261–271.
Nesher G, et al. (2004). Low-dose aspirin and
prevention of cranial ischemic complications in giant cell arteritis.
Arthritis and Rheumatism, 50(4): 1332–1337.
Hellmann DB (2009). Giant cell arteritis, polymyalgia
rheumatica, and Takayasu's arteritis. In GS Firestein et al., eds.,
Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp.
1409–1428. Philadelphia: Saunders Elsevier.
Both M, et al. (2006). Balloon angioplasty of arteries
of the upper extremities in patients with extracranial giant-cell arteritis.
Annals of the Rheumatic Diseases, 65(9):
1124–1130.