Polymyalgia rheumatica

A physical exam and lab tests can help your healthcare professional find the cause of your pain and stiffness. The exam may include checking your joints and nervous system, called a neurological exam. During the exam, your healthcare professional might gently move your head and limbs to check their range of motion.

Your diagnosis might change during treatment. Some people who are diagnosed with polymyalgia rheumatica are later diagnosed with rheumatoid arthritis or giant cell arteritis.

Tests you might have include:

• Blood tests. Besides checking your complete blood counts, your healthcare professional looks at two lab tests for signs of irritation and swelling, called inflammation. These tests are erythrocyte sedimentation rate, also called sed rate, and C-reactive protein. Not everyone with the condition has high levels of these proteins in their blood, but most do.
• Imaging tests. An ultrasound can tell whether you have inflammation of the joints and soft tissues and can help in the diagnosis of polymyalgia rheumatica. Some people have an MRI or a PET scan to look for other causes of joint pain.

Watching for giant cell arteritis

Your healthcare professional watches you for symptoms that can mean the onset of giant cell arteritis. Talk with your healthcare professional right away if you have any of the following:

• New headaches or headaches that don't go away.
• Jaw pain or tenderness.
• Blurred or double vision or vision loss.
• Tender scalp.

To confirm a diagnosis of giant cell arteritis, you may have an ultrasound or a biopsy of an artery in one of your temples. A biopsy involves removing a small sample of the artery for study under a microscope. The biopsy is done with a numbing medicine in the area where the artery is removed.

Treatment most often involves medicines to help ease your symptoms. It's common to get the condition again, called a relapse.

Medications

• Corticosteroids. A low dose of a corticosteroid you take by mouth, such as prednisone, most often treats polymyalgia rheumatica. You may feel rapid relief from pain and stiffness in 1 to 3 days.

  After 2 to 4 weeks of treatment, your healthcare professional might start to lower your dosage slowly. This depends on your symptoms and the results of blood tests. Because corticosteroids have side effects, the goal is to have you take the lowest dose that keeps symptoms from coming back.

  Many people with polymyalgia rheumatica need to have the corticosteroid treatment for 1 to 2 years or more. You have follow-up visits with your healthcare team often. This is to see how the treatment is working and to watch for side effects.

  Long-term use of corticosteroids can result in serious side effects. These may include weight gain, bone thinning, high blood pressure, diabetes and cloudy areas on your eyes that can lead to vision loss, called cataracts.

  Your healthcare team watches for side effects. You might need to change your dose or take medicines to manage corticosteroid treatment side effects.

• Calcium and vitamin D. You may take daily doses of calcium and vitamin D supplements to help prevent bone loss from corticosteroid treatment. The American College of Rheumatology suggests supplements of 1,000 to 1,200 milligrams of calcium and 600 to 800 international units of vitamin D for anyone taking corticosteroids for three months or more.

• Methotrexate (Trexall). Guidelines from the American College of Rheumatology and the European League Against Rheumatism suggest using methotrexate with corticosteroids in some people. This is to lower the dose of corticosteroids or for relapses.

  You take methotrexate by mouth to lower your immune system response. You may take it early in your treatment. Or you may take it later if symptoms return or corticosteroids don't work well enough.

• Sarilumab (Kevzara). The U.S. Food and Drug Administration has approved this medicine for people whose symptoms return. This medicine works by blocking a substance in the body that causes inflammation. You take this medicine as a shot every two weeks. It may relieve symptoms with a lower dose of corticosteroids.

Physical therapy

Most people who take corticosteroids for polymyalgia rheumatica return to the level of activity they were at before they got the condition. But if you've had to limit your activity for a time, physical therapy may help. Talk with your healthcare team about whether physical therapy is a good choice for you.

Healthcare professionals may suggest nonsteroidal anti-inflammatory medicines you get without a prescription to ease symptoms of polymyalgia rheumatica. These include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).

Healthy-lifestyle choices can help you manage the side effects that corticosteroid treatment can cause:

• Eat a healthy diet. Eat mainly fruits, vegetables, whole grains, and low-fat protein and dairy products. Limit salt, also called sodium, in your diet to prevent fluid buildup and high blood pressure.
• Exercise often. Talk with your healthcare team about exercise to help you strengthen bones and muscles.
• Get enough rest. Polymyalgia rheumatica can cause you to be tired. Your body needs rest to recover from exercise and daily activities.
• Use assistive devices. Think about using luggage and grocery carts, reaching aids, shower grab bars, and other devices to help make daily tasks easier.

Even if you feel better soon after you start treatment, you may be distressed about having to take medicine daily that can cause such serious side effects. Ask your healthcare team what you can do to stay healthier while you take corticosteroids.

Ask about local support groups in your area. Talking with others who are living with the same challenges might help.

You'll likely start by seeing your main healthcare professional. Your healthcare professional might send you to a specialist in joint and muscle conditions, called a rheumatologist.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do before the appointment.

Make a list of:

• Your symptoms, including any that may not seem linked to the reason you scheduled the appointment, and when they began.
• Key personal information, including major stresses or recent life changes, and personal and family medical history.
• Any medicines, vitamins and other supplements you take, including dosages.
• Questions to ask your healthcare team.

Take a family member or friend with you, if you can, to help you keep what you learn.

For polymyalgia rheumatica, questions to ask include:

• What's the most likely cause of my symptoms?
• What are other possible causes of my symptoms?
• What tests do I need?
• Is this a condition likely to go away or to last?
• What treatments are there? Which do you suggest?
• I have other health conditions. How can I best manage them together?
• Do you have brochures or other printed material that I can have? What websites do you suggest?

What to expect from your doctor

Your healthcare team likely will ask you questions, such as:

• Where is your pain or stiffness?
• How would you rate your pain on a scale of 1 to 10?
• Are symptoms worse at certain times of the day or night?
• How long does stiffness last after you wake in the morning or after a period of not being active?
• Does the pain or stiffness limit your activities?
• Have you had new or bad headaches or jaw pain?
• Has your vision changed?