Polymyalgia rheumatica and giant cell arteritis are
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.
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
stroke or mini-strokes. People who have giant cell arteritis need
treatment right away.
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
Symptoms of polymyalgia rheumatica often start suddenly and get worse without
treatment. The problem can cause:
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:
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
Your doctor will give you
steroid medicines to treat the inflammation. People often feel better in a day or two. 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.
These problems most often occur after the age of 50. And the risk increases after that as you get older.
Learning about polymyalgia rheumatica and giant cell arteritis:
polymyalgia rheumatica (PMR) often occur suddenly and
get worse without treatment. Typical polymyalgia rheumatica symptoms
include pain and morning stiffness in the:
These symptoms are caused by
inflammation of joints,
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
Other symptoms of polymyalgia rheumatica may
giant cell arteritis (GCA) can develop gradually or
suddenly. They require immediate treatment.
Symptoms of giant
cell arteritis may include:
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).
polymyalgia rheumatica (PMR) and
giant cell arteritis (GCA), your doctor will do a
physical exam. He or she will 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
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
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
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 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
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.
After your symptoms have gone
away and your lab tests are normal, ongoing treatment for
polymyalgia rheumatica (PMR) and
giant cell arteritis (GCA) usually includes continued
gradually lowers the amount of medicine you take. How quickly he or she does
this varies with each person.
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
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 may include regular appointments or phone calls to
discuss your symptoms. And you may need tests to measure your
erythrocyte sedimentation rate (ESR) or your
C-reactive protein (CRP) value.
If you need long-term
corticosteroid treatment for either condition, you are at risk for bone
thinning (osteoporosis). This is because corticosteroids
reduce how well your body takes in calcium, which is important in building
strong bones. Your doctor may recommend a bone density (DXA) 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
polymyalgia rheumatica (PMR) and
giant cell arteritis (GCA), your symptoms may come back
(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 sometimes
people have a relapse over the first 2 years that is not
related to how corticosteroids are used. 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
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.
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. Be safe with medicines. Read and follow all instructions on the label.
aspirin if you have giant cell arteritis. This is
because some studies show that doing so may reduce the risk of vision loss,
transient ischemic attacks (blood flow to the brain is
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:
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 well this treatment works.3
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
reduce symptoms of giant cell arteritis.4
To feel your best during treatment for
polymyalgia rheumatica (PMR) or
giant cell arteritis (GCA):
If any of your symptoms get worse or come back, contact
your doctor or nurse.
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.
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.
website offers patient information fact sheets about rheumatic diseases, about
medicines used to treat rheumatic diseases, and about care
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.
Hellmann DB, Imboden JB Jr (2012). Musculoskeletal and immunologic disorders. In SJ McPhee, MA Papadakis, eds., 2012 Current Medical Diagnosis and Treatment, 51st ed., pp. 787–846. New York: McGraw-Hill.
Spiera RF, Paget SA (2012). Polymyalgia rheumatica and temporal arteritis. In L Goldman, A Shafer, eds. Goldman's Cecil Medicine, 24th ed., pp. 1728–1731. Philadelphia: Saunders.
Hellmann DB (2013). Giant cell arteritis, polymyalgia rheumatica, and Takayasu's arteritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 2, pp. 1461–1480. Philadelphia: Saunders.
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.
April 10, 2013
Adam Husney, MD - Family Medicine
& Anne C. Poinier, MD - Internal Medicine
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