Polymyalgia rheumatica

The usual symptoms

Stiffness is more marked in the morning or after being still, often lasting more than 45 minutes. Pain affects both sides of the body: the shoulders, neck and hips, sometimes the upper arms and thighs. It may come with fatigue, reduced appetite, weight loss and low mood. Movement is often limited by pain. True muscle weakness calls for investigation of other causes. Polymyalgia is not a synonym for any muscle pain in older people.

Although the name of the disease mentions muscles, pain and limitation are often linked to inflammation in structures around the joints, such as bursae and tendon sheaths (see tendinitis and bursitis). A patient may be unable to raise an arm because of pain, without a true loss of muscle strength.

How the diagnosis is made

The rheumatologist reviews the pattern of pain, its duration and the examination. Inflammatory markers (ESR, CRP), a blood count and tests to exclude conditions that mimic it may be recommended, such as rheumatoid arthritis, myopathies and thyroid disorders (hypothyroidism). Ultrasound can help in selected cases, showing bursitis or tenosynovitis of the shoulder. Improvement after corticosteroids can support the assessment but does not by itself confirm the diagnosis. If there is objective weakness, atypical symptoms or an inappropriate response to treatment, the doctor considers alternatives; age and distribution of symptoms help but are not enough for the diagnosis.

The link with giant cell arteritis

Polymyalgia can coexist with inflammation of the arteries of the head (giant cell arteritis). When the arteries supplying the eye are affected, there is a risk of irreversible loss of vision. So new headache, jaw pain on chewing and visual disturbance call for urgent action even if the shoulder pain has improved.

In this situation, the doctor may begin high-dose corticosteroids before final confirmation, to protect vision. Vascular ultrasound or arterial biopsy, when recommended, are arranged by the relevant service. They must not become a reason to delay urgent treatment.

Treatment and why therapy is reduced gradually

Corticosteroids (prednisolone) are the main treatment; the low-to-moderate starting dose is reduced gradually according to response and the medical plan, and treatment usually lasts one to two years, though it varies. In certain cases additional steroid-sparing drugs are needed. Too rapid a reduction may be accompanied by a return of inflammation. Prolonged use of corticosteroids also affects the natural production of cortisol, so abrupt stopping can cause a problem other than recurrent pain. Do not stop corticosteroids suddenly.

Check-ups assess symptoms, inflammation and side effects, including blood pressure, glycemia (diabetes may worsen), infections and bone health (risk of osteoporosis). If treatment is not improving the condition as expected, the diagnosis and plan are reconsidered. Do not take extra doses just because you have pain without discussing what is causing it.

What helps during corticosteroid treatment

Corticosteroids are very effective in polymyalgia, but use over months or years calls for protective measures. Take the dose in the morning with food, because this mimics the natural rhythm of cortisol and reduces insomnia and stomach irritation. Do not stop abruptly, and if you miss a dose or vomit and cannot keep it down, contact the doctor. During prolonged treatment the body may not produce enough cortisol by itself; during a severe illness, surgery or serious infection an adjusted dose may be needed, so tell every doctor about your treatment.

Possible side effects are monitored: rising glucose (check as directed, especially if you have diabetes or a family history), rising blood pressure and weight, fluid retention, changes of mood and sleep, a higher risk of infections and loss of bone. For bones, dietary calcium (milk, cheese, legumes, leafy green vegetables), vitamin D according to measurement, walking and weight-bearing exercise, stopping smoking and limiting alcohol help; the doctor assesses the need for bone-protecting medicine when treatment is expected to be long. Have the eyes checked periodically too, because corticosteroids can promote cataract or raised eye pressure.

What to track and when to call

Keep a simple diary: the duration of morning stiffness, the ability to raise the arms, rise from a chair and walk, and any new headache. Most patients feel clear improvement within days to a few weeks of starting treatment; the lack of this response is a reason to reconsider the diagnosis. A return of pain while the dose is being reduced is common and does not always mean treatment has failed; it is a reason to tell the doctor before changing the dose yourself.

Contact the doctor immediately for a new headache or scalp tenderness, jaw pain on chewing, any change in vision, fever, or signs of infection during treatment. At the visit, bring the list of medicines and your home glucose and blood pressure readings.

What helps in daily life

Adapted activity and the recommended exercises help function. Discuss nutrition, calcium, vitamin D and bone protection with the doctor. If symptoms return while the dose is being reduced, tell the team before changing it yourself. Check-ups take place every 6 months to a year, or sooner when the doctor considers it reasonable, and more often during dose reduction.

Care at Tirana Polyclinic: we offer rheumatology consultation, tests and follow-up of treatment. Joint ultrasound and physiotherapy are included when indicated. Other examinations are recommended at the relevant service and the results are interpreted by the specialist.