This article originally appeared in the September 2006 Harvard Women’s Health Watch and is provided courtesy of Harvard Health Publications.

Polymyalgia rheumatica
Getting out of bed in the morning can be a challenge — especially for the many people who have this inflammatory condition.

Anyone over age 50 may be accustomed to a little joint stiffness and muscle soreness the morning after a challenging workout or some heavy gardening. Generally, a hot shower, massage, or good night’s rest will put us right. But for women with polymyalgia rheumatica (PMR), those common remedies don’t suffice. PMR may not be life-threatening, but it can seriously limit a woman’s daily activities and take a heavy toll on her sleep and well-being.

PMR may come on gradually over days or weeks, but it often appears suddenly. A woman may feel fine one day but wake up the next morning feeling as if her health has inexplicably deteriorated. Left untreated, the condition may last for months to years before gradually subsiding. However, with proper diagnosis and treatment, the symptoms can be eased almost as quickly as they appear.

What is PMR?
PMR is an inflammatory disorder that causes aching and stiffness starting in the neck, shoulders, and hips. It affects mainly adults in their 60s and 70s and is rarely diagnosed before age 50. The disorder is twice as likely to occur in women and is more common in whites than in blacks. Among Caucasians, PMR is about as common as rheumatoid arthritis, affecting nearly 1% of people over age 50.

The inflammation that causes PMR generally occurs in the muscles and soft tissues of the shoulders and hips and in the bursa (small fluid-filled sacs that cushion tendons where they attach to bone) in those areas. We don’t know exactly what triggers the condition. Scientists suspect it’s a combination of factors, including immune system abnormalities, genes, and aging.

The aching and stiffness usually last 30 minutes or more and are at their worst first thing in the morning (or after a period of inactivity). The discomfort often causes nighttime awakenings, and turning over in bed may be difficult. Some people with PMR also have flulike symptoms, including low-grade fever, fatigue, and weight loss.

Diagnosing and treating PMR
There is no definitive way to diagnose PMR. To make the diagnosis, a clinician will review a woman’s health history and perform a physical exam. The symptoms of PMR are common, so it’s a challenge to exclude other causes, such as rheumatoid arthritis, fibromyalgia, muscle conditions, tendonitis, bursitis, infection, thyroid problems, or cancer. Doing so may require several lab tests and x-rays.

A person with PMR usually feels stiff and achy in at least two of three areas: the neck, the shoulders or upper arms, and the hips or upper thighs. Joints generally aren’t swollen or red, as they are in rheumatoid arthritis, but occasionally, a joint in the hand, ankle, or foot will be swollen. X-rays are usually normal.

The most characteristic laboratory finding in PMR is an elevated erythrocyte sedimentation rate (ESR), sometimes called a “sed rate” (see “What’s a sedimentation rate?”). This blood test measures the level of inflammation in the body. When other conditions that cause inflammation are ruled out, a high ESR number (50 or greater) in a person over age 50 with PMR symptoms is strong evidence for the disease.

PMR often disappears on its own within a few years, but not without taking a heavy toll on a woman’s quality of life. Non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen can help with mild symptoms. But PMR generally responds best to very low doses of corticosteroid medications (“steroids,” for short), such as prednisone. In fact, symptoms improve almost overnight. This rapid response helps confirm a PMR diagnosis: If low doses of steroids don’t help, PMR is probably not the cause. Doses can be further reduced as symptoms improve, but relapse is likely if they’re stopped too soon. Most people need to continue taking a very low dose for six months to two years.

The company it keeps
PMR is not dangerous in itself, but it often occurs in people who have a more serious inflammatory condition called giant cell arteritis (GCA). In this condition, the lining of arteries in the head, neck, and arms becomes inflamed, narrowing the arteries and causing symptoms such as headache (especially around the temples, which may be tender to the touch), scalp tenderness, and pain or weakness in the jaw. The most common dangerous complication of GCA is blindness, which almost never occurs if the condition is recognized and treated promptly. Untreated, GCA can also lead to stroke or an aortic aneurysm — a bulge in the large artery that runs between the chest and abdomen. The only way to definitively diagnose GCA is to take a biopsy of an artery in the temple and examine it under a microscope for evidence of the condition.

PMR occurs in about 50% of people who have GCA, and 15% of people with PMR will also develop GCA. It’s not clear how or why this relationship exists. To reduce the small but definite risk of permanent blindness from GCA, patients with PMR should take a high dose of prednisone once early in the course of symptoms.

Although long-term, high-dose steroid treatment has many side effects, the low doses used in treating PMR — and the high doses used for a relatively short time in people with GCA — rarely cause problems. However, women should be aware that taking even low doses of steroids for several years slightly increases their risk for steroid-related conditions, including osteoporosis, glaucoma, cataracts, high blood pressure, weight gain, jumpiness, and insomnia. When you take steroids, it’s important for your clinician to properly monitor the effects and taper the dose.