Overview of Polymyalgia Rheumatica and Giant Cell Arteritis
Polymyalgia rheumatica and giant cell arteritis are closely linked inflammatory disorders that almost always occur in people older than age 50. Polymyalgia rheumatica causes muscle pain and stiffness in the shoulders, upper arms, hip area, and sometimes the neck. The ache and stiffness are usually worse in the morning or when you have not been moving for a while. They can sometimes be very debilitating and tend to improve with activity.
People with polymyalgia rheumatica sometimes have another disorder called giant cell arteritis, which is associated with inflammation of arteries, especially those located on each side of the head, scalp, and the aorta (the large artery that carries blood from the heart) and its main branches. Headaches, scalp tenderness, and jaw pain are common features of giant cell arteritis. If the blood vessels that nourish the eyes are affected, there may be visual problems such as fleeting or permanent vision loss or double vision. It is important to seek treatment right away if you have visual symptoms, because if left untreated they may potentially lead to permanent blindness. Giant cell arteritis is also known as temporal arteritis and Horton disease.
Both disorders generally respond well to treatment, although it is common for symptoms to recur after decreasing or stopping therapy.
Who Gets Polymyalgia Rheumatica and Giant Cell Arteritis?
You are more likely to get polymyalgia rheumatica and giant cell arteritis if you have certain risk factors. These include:
- Age. They occur almost exclusively in people older than age 50, typically in people in their late 60s and in their 70s.
- Sex. Women get these disorders more frequently than men do.
- Ethnic and racial background. They are more common in Caucasians, especially people of Northern European ancestry, but are also observed in patients of other ethnic and racial backgrounds.
Symptoms of Polymyalgia Rheumatica and Giant Cell Arteritis
Polymyalgia rheumatica and giant cell arteritis are related conditions, with some people having symptoms of both. About 10 percent of people with polymyalgia rheumatica have giant cell arteritis, and about 50 percent of those with giant call arteritis have polymyalgia rheumatica.
Symptoms of polymyalgia rheumatica include:
- Pain and stiffness in the shoulders, neck, upper arms, and hip area. The pain and stiffness are usually worse upon waking in the morning or after resting, and usually last an hour or more. You may have difficulty with activities like getting up from bed or a chair, and dressing and brushing hair. It is also typical to have difficulty raising your arms above the shoulders.
- Flu-like symptoms, including low-grade fever, weakness, loss of appetite, and weight loss.
- Occasional swelling of the wrists or joints in the hands.
The symptoms of polymyalgia rheumatica can come on quickly, usually in a matter of a few days, and in some cases even overnight.
Symptoms of giant cell arteritis include:
- Headaches and scalp tenderness. These are the most common symptoms. The headache pain may be severe and is usually located in the temple areas. Some people notice tenderness of the scalp, often prior to the onset of headaches.
- Jaw pain. People sometimes experience jaw pain, especially when chewing.
- Visual disturbances. Many people have episodes of double vision or vision loss in one or both eyes. At first, the visual disturbances may last only a few minutes and resolve on their own. It is important to see a health care provider right away if you develop visual symptoms, because if left untreated, they can lead to permanent vision loss within hours or days.
- Flu-like symptoms. These include low-grade fever, weakness, loss of appetite, and weight loss.
- Large artery involvement, including inflammation of the aorta and its major branches can lead to bulging of the artery (aneurysms) or, due to blockages in the arteries, cause cramping or aching pain in the arms or legs with activity. At times, inflammation of the aorta does not cause any symptoms but is detected by chance on imaging studies (such as CT or MRI).
In most people, symptoms of giant cell arteritis develop over the course of weeks or months, but in some cases the onset is more abrupt. Some people may have only large artery involvement (such as the aorta) and not have any symptoms in the head or scalp; these people may experience flu-like symptoms or no symptoms at all.
Cause of Polymyalgia Rheumatica and Giant Cell Arteritis
Inflammation causes polymyalgia rheumatica and giant cell arteritis, but scientists do not know what triggers it. Some studies have linked certain gene variants with the disorders, but these genetic links have not been consistent across different populations. Because the disorders occur in older people, the aging process may contribute to the disease onset.