POLYMYALGIA RHEUMATICA

General Information

DEFINITION--Inflammatory disease of the large arteries, especially those in the head and neck. Symptoms of polymyalgia rheumatica (stiffness and pain in muscles) and temporal arteritis (inflammation of the walls of the arteries that pass over the temples in the scalp) are the same, so the two diseases may be identical.

BODY PARTS INVOLVED--Muscles; temporal arteries; eyes; connective tissue.

SEX OR AGE MOST AFFECTED--Adults over 50. The disease occurs 4 times more often in women than men.

SIGNS & SYMPTOMS--

The following symptoms may resemble those of an infection such as influenza.

• Low fever.
• Muscle stiffness, aches and pains--especially in the morning. The muscles involved are usually those of the trunk, upper arms and legs.
• Severe, throbbing headache (usually in one temple).
• Redness, swelling, tenderness and pulsating nodules along the temporal artery on one side of the head.
• Appetite loss.

CAUSES--An autoimmune disorder in which the body's immune system attacks and destroys its own tissues (especially connective tissue). The underlying cause is unknown.

RISK INCREASES WITH--Adults over 60, especially women.

HOW TO PREVENT--No specific preventive measures.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Laboratory studies, such as sedimentation rate (See Glossary), white-blood-cell count and blood tests for anemia.
• Biopsy (See Glossary) of a small amount of tissue or fluid of the temporal artery and muscle.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment for this disorder or problems associated with it. These may include heart disease, high blood pressure or decreased blood supply to the bowel.
• Surgery, if the bowel develops intestinal gangrene.

POSSIBLE COMPLICATIONS

> Without treatment: Loss of vision (if blood vessels to the eyes are involved, it's an emergency); coronary-artery disease; stroke; poor blood circulation to the arms and legs.

> With treatment: Cortisone drugs may be necessary for many months. Complications of long-term cortisone use are significant, including osteoporosis and peptic-ulcer disease.

PROBABLE OUTCOME--Usually curable, but relapse is possible.

How To Treat

GENERAL MEASURES--

• Apply heat to the painful side of the head. You may use warm compresses or a heat lamp.
• Gently massage the back of the neck and sore muscles.
• See Arthritis in Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Cortisone drugs in high doses until the acute phase ends. These dramatically relieve symptoms by altering the inflammation causing them. For continuing treatment with cortisone, the lowest possible single dose taken every other day may keep symptoms under control.
• Immunosuppressive drugs, either alone or with corticosteroids, if other treatment is not successful.
• Heart medications (if the heart is involved).
• Antihypertensive drugs (if high blood pressure is part of the problem).

ACTIVITY--No restrictions.

DIET--No special diet.

Call Your Doctor If

• You have symptoms of polymyalgia rheumatica and temporal arteritis.
• The following occurs during treatment: Temperature of 101F (38.3C). Blood in the urine. Shortness of breath. Chest pain. Bloody bowel movements. Severe abdominal pain. Any illness with fever.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.