Diagnosis
No single test is available to definitively diagnose polymyalgia rheumatica. To diagnose the condition, a physician considers the:
The most typical laboratory finding in people with polymyalgia rheumatica is an elevated erythrocyte sedimentation rate, commonly referred to as the sed rate. This test measures how quickly red blood cells fall to the bottom of a test tube of unclotted blood. Rapidly descending cells (an elevated sed rate) indicate inflammation in the body. While the sed rate measurement is a helpful diagnostic tool, it alone does not confirm polymyalgia rheumatica. An abnormal result indicates only that tissue is inflamed, which also is a symptom of many types of arthritis and/or other rheumatic diseases.
Before making a diagnosis of polymyalgia rheumatica, the doctor may perform additional tests to rule out other conditions, including rheumatoid arthritis, because symptoms of polymyalgia rheumatica and rheumatoid arthritis can be similar.
The doctor may recommend a test for rheumatoid factor (RF). RF is an antibody (a special protein) sometimes found in the blood. People with rheumatoid arthritis are likely to have RF in their blood, but most people with polymyalgia rheumatica do not. If the diagnosis still is unclear, a physician may conduct additional tests to rule out other disorders.
Doctors and patients both need to be aware of the risk of giant cell arteritis in people with polymyalgia rheumatica and should be on the lookout for symptoms of the disorder. Severe headaches, jaw pain, and vision problems are typical symptoms of giant cell arteritis. In addition, physical examination may reveal an abnormal temporal artery:
- tender to the touch
- inflamed
- a reduced pulse
Because of the possibility of permanent blindness, a temporal artery biopsy is recommended if there is any suspicion of giant cell arteritis.
In a person with giant cell arteritis, the biopsy will show abnormal cells in the artery walls. Some patients showing symptoms of giant cell arteritis will have negative biopsy results. In such cases the doctor may suggest a second biopsy.
Treatment
Polymyalgia rheumatica usually disappears without treatment in 1 to several years. With treatment, however, symptoms disappear quickly, usually in 24 to 48 hours. If there is no improvement, the doctor is likely to consider other possible diagnoses.
The treatment of choice is corticosteroid medication, usually prednisone.
Polymyalgia rheumatica responds to a low daily dose of prednisone. The dose is increased as needed until symptoms disappear. Once symptoms disappear, the doctor may gradually reduce the dosage to determine the lowest amount needed to alleviate symptoms. The amount of time that treatment is needed is different for each patient. Most patients can discontinue medication after 6 months to 2 years. If symptoms recur, prednisone treatment is required again.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen also may be used to treat polymyalgia rheumatica. For most, NSAIDs alone are not enough to relieve symptoms.
Giant cell arteritis carries a small but definite risk of blindness. The blindness is permanent once it happens. A high dose of prednisone is needed to prevent blindness and should be started as soon as possible, perhaps even before the diagnosis is confirmed with a temporal artery biopsy. When treated, symptoms quickly disappear. Typically, people with giant cell arteritis must continue taking a high dose of prednisone for 1 month. Once symptoms disappear and the sed rate is normal and there is no longer a risk of blindness, the doctor can begin to gradually reduce the dose. When treated properly, giant cell arteritis rarely recurs.
People taking low doses of prednisone rarely experience side effects. Side effects are more common among people taking higher doses. But all patients should be aware of potential effects, which include:
- fluid retention
- weight gain
- rounding of the face
- delayed wound healing
- bruising easily
- diabetes
- muscle wasting
- glaucoma
- increased blood pressure
- decreased calcium absorption, which can lead to osteoporosis
- stomach irritation
People taking corticosteroids may have some side effects or none at all. A patient should report any side effects to the doctor. When the medication is stopped, the side effects disappear. Because prednisone and other corticosteroids can change the body’s natural production of cortisol, you should not stop taking the medication unless instructed by the doctor. The patient and doctor must work together to gradually reduce the drug.
Related Resources
Source: Questions & Answers on Polymyalgia Rheumatica and Giant Cell Arteritis, NIAMS
