Saanichton, BC

Dr. Miguel A. Lipka

Polymyalgia Rheumatica and Giant Cell Arteritis

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Polymyalgia rheumatica is a rheumatic disorder associated with moderate-to-severe musculoskeletal pain and stiffness in the neck, shoulder, and hip area.

Giant cell arteritis is a disorder that results in inflammation of arteries of the scalp, neck, and arms. This inflammation causes the arteries to narrow, impeding adequate blood flow.

Polymyalgia rheumatica and giant cell arteritis frequently occur together, although it is unclear how or why. Some people with polymyalgia rheumatica also develop giant cell arteritis either simultaneously, or after the musculoskeletal symptoms have disappeared. Other people with giant cell arteritis also have polymyalgia rheumatica at some time while the arteries are inflamed. It is important that doctors look for symptoms of the arteritis in anyone diagnosed with polymyalgia rheumatica.

Polymyalgia rheumatica and giant cell arteritis are both quite common. In North America, it is estimated that 700 per 100,000 people in the general population over 50 years of age develop polymyalgia rheumatica. An estimated 200 per 100,000 people over 50 years of age develop giant cell arteritis.

Caucasian women over the age of 50 have the highest risk of developing polymyalgia rheumatica and giant cell arteritis. Both conditions almost exclusively affect people over the age of 50. The incidence of both peaks between 70 and 80 years of age. Although women are more likely than men to develop the conditions, research suggests that men with giant cell arteritis are more likely to suffer potentially blinding eye involvement.

Most people with polymyalgia rheumatica and giant cell arteritis lead productive, active lives. The treatment of choice for both polymyalgia rheumatica and giant cell arteritis is corticosteroid medication, usually prednisone. The duration of drug treatment differs by patient. Once treatment is discontinued, polymyalgia may recur; but symptoms respond rapidly to prednisone. When properly treated, giant cell arteritis rarely recurs.

Whether taken on a long-term basis for polymyalgia rheumatica or for a shorter period for giant cell arteritis, prednisone carries a risk of side effects. Although long-term use and/or higher doses carry the greatest risk, people taking the drug at any dose or for any length of time should be aware of the potential side effects, which include:

  • Fluid retention and weight gain
  • Rounding of the face
  • Delayed wound healing
  • Bruising easily
  • Diabetes
  • Myopathy (muscle wasting)
  • Glaucoma
  • Increased blood pressure
  • Decreased calcium absorption in the bones, which can lead to osteoporosis
  • Irritation of the stomach
  • Increase in infections

People taking corticosteroids may have some side effects or none at all. Anyone who experiences side effects should report them to his or her doctor. When the medication is stopped, the side effects disappear. Because prednisone and other corticosteroid drugs reduce the body’s natural production of corticosteroid hormones, which are necessary for the body to function properly, it is important not to stop taking the medication unless instructed by a doctor to do so. The patient and doctor must work together to gradually reduce the medication.

Polymyalgia Rheumatica

Polymyalgia rheumatica is a rheumatic disorder associated with moderate-to-severe musculoskeletal pain and stiffness in the neck, shoulder, and hip area. Stiffness is most noticeable in the morning or after a period of inactivity, and typically lasts longer than 30 minutes.

This disorder may develop rapidly; in some people it comes on literally overnight. But for most people, polymyalgia rheumatica develops more gradually.

The cause of polymyalgia rheumatica is not known. But it is associated with immune system problems, genetic factors, and an event, such as an infection, that triggers symptoms. The fact that polymyalgia rheumatica is rare in people under the age of 50 and becomes more common as age increases, suggests that it may be linked to the aging process.

In addition to the musculoskeletal stiffness mentioned earlier, people with polymyalgia rheumatica also may have:

  • Flu-like symptoms
  • Fever
  • Weakness
  • Weight loss

Polymyalgia rheumatica responds to a low daily dose of prednisone that is increased as needed until symptoms disappear. At this point, the doctor may gradually reduce the dosage to determine the lowest amount needed to alleviate symptoms. Most patients can discontinue medication after 6 months to 2 years. If symptoms recur, prednisone treatment is required again.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin), also may be used to treat polymyalgia rheumatica. The medication must be taken daily, and long-term use may cause stomach irritation. For most patients, NSAIDs alone are not enough to relieve symptoms.

Even without treatment, polymyalgia rheumatica usually disappears in 1 to several years. With treatment, however, symptoms disappear quickly, usually in 24 to 48 hours. If prednisone doesn’t bring improvement, the doctor is likely to consider other possible diagnoses.

Giant Cell Arteritis

Giant cell arteritis, also known as temporal arteritis and cranial arteritis, is a disorder that results in inflammation of arteries of the scalp (most apparent in the temporal arteries, which are located on the temples on each side of the head), neck, and arms. This inflammation causes the arteries to narrow, impeding adequate blood flow.

Early symptoms of giant cell arteritis may resemble flu symptoms such as fatigue, loss of appetite, and fever. Symptoms specifically related to the inflamed arteries of the head include:

  • Headaches
  • Pain and tenderness over the temples
  • Double vision or visual loss
  • Dizziness
  • Problems with coordination and balance
  • Pain may affect the jaw and tongue, especially when eating
  • Opening the mouth wide may become difficult
  • In rare cases, giant cell arteritis causes ulceration of the scalp

Giant cell arteritis is treated with high doses of prednisone. If not treated promptly, the condition carries a small but definite risk of blindness or stroke, so prednisone should be started as soon as possible, perhaps even before confirming the diagnosis with a temporal artery biopsy.

As with polymyalgia rheumatica, the symptoms of giant cell arteritis quickly disappear with treatment; however, high doses of prednisone are typically maintained for 1 month. Once symptoms disappear and the sed rate is normal, there is much less risk of blindness. At that point, the doctor can begin to gradually reduce the prednisone dose.