Polymyalgia rheumatica

Polymyalgia rheumatica is a condition that causes pain, stiffness and inflammation, mostly around the shoulders, neck and hips.

Polymyalgia rheumatica often causes pain and stiffness, mostly in the shoulders, neck and hips. These symptoms can come on quickly, over a few days or weeks. Usually both sides of the body are affected.

The stiffness tends to be worst first thing in the morning, just after you wake up. It usually starts to ease after about 45 minutes, once you get moving.

Polymyalgia rheumatica may also cause:

• high temperature (fever) and sweating
• extreme tiredness (fatigue)
• loss of appetite
• weight loss
• depression

If you have been diagnosed with polymyalgia rheumatica and you suddenly develop any of the following, speak to a doctor urgently or phone the 16263 health line:

• a persistent and severe headache
• jaw pain or cramping in your jaw muscles which is worse when you're eating
• pain in your tongue when chewing

Sudden vision loss or a change in your vision, such as double vision, is just as serious if you have polymyalgia rheumatica. Contact an optician immediately, or get in touch with a doctor or the 16263 health line.

Polymyalgia rheumatica can take a long time to diagnose. You may need several different tests, because its symptoms are shared by other health conditions, and those have to be ruled out first.

There's no specific test for polymyalgia rheumatica. But you should have blood tests before starting any corticosteroid treatment, to look for things like signs of inflammation.

An X-ray or ultrasound scan may also be used to look at the condition of your bones and joints.

No one knows what causes polymyalgia rheumatica. Genetic and environmental factors can play a part, though.

Age matters too. Most people diagnosed with polymyalgia rheumatica are over 70, and it's very rare in people younger than 50.

It's also more common in women than in men.

The main treatment for polymyalgia rheumatica is a corticosteroid medicine called prednisolone. It comes as a pill, and your doctor will prescribe it for you.

Prednisolone blocks certain chemicals in the body that cause inflammation.

You'll be given a higher dose at first. This is then reduced slowly, and the whole process is likely to take about a year.

Sometimes your doctor will prescribe other medicines alongside the corticosteroids for polymyalgia rheumatica. These can help prevent relapses, or they may let your dose of prednisolone be reduced. Rheumatology doctors usually add them. The options include a weekly dose of methotrexate or a daily dose of leflunomide.

Painkillers may also be recommended. They can help if you have arthritis or chronic pain as well.

Taking steroids for a long time brings side effects, so your doctor may also prescribe medicine to protect your bones. Calcium and vitamin D supplements and bisphosphonates are examples. You may also be given proton pump inhibitors (PPIs) to protect your stomach.

If you have been diagnosed with polymyalgia rheumatica, you will need to see your doctor regularly. At these visits, the doctor will check:

• how well you're responding to treatment
• whether your dose of prednisolone needs to be adjusted
• how well you're coping with the side effects of the medicine

You will also have blood tests at these visits.

You will usually have a follow-up visit within a week of starting your steroid treatment, so the doctor can see how you are responding. After that, you'll have regular checks to make sure the inflammation levels in your blood are normal while the steroids are slowly reduced.

If your symptoms come back at any point during treatment, speak to your doctor. The dose of your medicine may need to be changed. Your doctor may also refer you to a rheumatologist.