Polymyalgia rheumatica and giant cell arteritis (temporal arteritis)
Polymyalgia rheumatica, sometimes referred to as PMR, causes pain, stiffness and inflammation in muscles around the shoulders, neck and hips.
Giant cell arteritis, or GCA, is also known as temporal arteritis. This causes inflammation in arteries in the head and neck.
Around half of those diagnosed with giant cell arteritis will also develop polymyalgia rheumatica.
What are the symptoms of polymyalgia rheumatica?
Symptoms tend to develop quickly and, in addition to muscle pain, other symptoms may include the following:
What is giant cell arteritis (temporal arteritis)?
Giant cell arteritis causes inflammation that damages large and medium-sized arteries. The name of the condition stems from the fact that some of the affected arteries provide blood to the head including the temples.
What are the symptoms of temporal arteritis?
Giant cell arteritis has several symptoms including:
- Severe headaches, the most common symptom.
- Scalp tenderness.
- Jaw or facial soreness, especially with chewing.
- Vision changes or distorted vision caused by decreased blood flow.
- Stroke in less than 5% of patients, caused by decreased blood flow.
- The large blood vessels may become narrowed or enlarged ( aneurysm). If narrowing occurs in the blood vessels leading to the arms or legs, the person may notice fatigue or aching in the limbs, due to a reduced blood supply. Your doctor may notice weak or absent pulses.
- Other symptoms may include a fever, weight loss, night sweats, depression, fatigue, and a general feeling of being sick.
How are polymyalgia rheumatica and giant cell arteritis diagnosed?
If a doctor suspects polymyalgia rheumatica after listening to a person’s symptoms and doing an examination, blood tests will likely be done to help confirm the diagnosis. The blood tests will help test for inflammation as well as help rule out other possible causes of the symptoms such as rheumatoid arthritis or an underactive thyroid.
Everyone with polymyalgia rheumatica is also tested for giant cell arteritis. This, too, starts with the examination and listening to the person’s symptoms.
If giant cell arteritis is suspected but less convincing features are present, a temporal artery biopsy may confirm the diagnosis. The biopsy is taken from a part of the artery located in the hairline, in front of the ear. In most cases the biopsy is helpful, but in some individuals it may be negative or normal, even though the person does have temporal arteritis.
How are polymyalgia rheumatica and giant cell arteritis treated?
Yes. Some other conditions that may be confused with polymyalgia rheumatica include:
- Rheumatoid arthritis
- Inflammation of blood vessels ( vasculitis)
- Chemical and hormonal abnormalities
- A variety of muscle diseases
How are polymyalgia rheumatica and temporal arteritis treated?
There is no known cure for polymyalgia rheumatica and giant cell arteritis, but these conditions can be treated and controlled. Corticosteroids - often called ‘steroids’ - help to rapidly relieve the symptoms of both polymyalgia rheumatica and giant cell arteritis.
Treatment with steroids - usually in the form of prednisolone - is mandatory for giant cell arteritis to prevent serious complications such as blindness. Low doses of steroids are often successful in treating polymyalgia rheumatica. Higher doses are often required to treat giant cell arteritis.
The excellent response to treatment is so uniform that a lack of dramatic improvement within days would make the diagnosis of giant cell arteritis or polymyalgia rheumatica doubtful.