Polymyalgia rheumatica is a syndrome characterized by severe pain and stiffness in the muscles of the neck, shoulder girdles, low back, hips and thighs. There is no corresponding weakness of the muscles.

It is thought that polymyalgia rheumatica is a result of blood vessels becoming inflamed.

The name polymyalgia rheumatica actually comes from Greek words. In Greek, 'poly' means 'many,' 'my' means 'muscle,' and 'algia' means 'pain' (many muscle pain) and 'rheumatica' refers to 'muscle and soft tissue.'

A condition associated with polymyalgia rheumatica is called giant cell arteritis. It sometimes occurs in people who have polymyalgia rheumatica. It causes the arteries on the upper front side of the head, called the temporal arteries, to narrow. The arteries can become blocked and this can result in loss of vision.

The warning signs of polymyalgia rheumatica include:

Giant cell arteritis also goes away on its own over a period of years. However, treatment is essential to minimize the chances of blindness.

Your active involvement in developing your prescribed treatment plan is essential.

Medicine

NSAIDs reduce pain when taken at a low dose, and relieve inflammation when taken at a higher dose. NSAIDs such as ASA (Aspirin, Anacin, etc.) and ibuprofen (Motrin IB, Advil, etc.) can be purchased without a prescription. Examples of NSAIDs that require a prescription include Naprosyn, Relafen, Indocid, Voltaren, Feldene, and Clinoril. The various NSAIDs and Aspirin®, if taken in full doses, usually have the same levels of anti-inflammatory effect. However, different individuals may experience greater relief from one medication than another. Taking more than one NSAID at a time increases the possibility of side effects, particularly stomach problems such as heartburn, ulcers and bleeding. People taking these medications should consider taking something to protect the stomach, such as misoprostol (Cytotec).

Cortisone is a steroid that reduces inflammation and swelling. It is a hormone naturally produced by the body. Corticosteroids are man-made drugs that closely resemble cortisone.  The most common form of corticosteroid is called prednisone, taken in pill form. Prednisone use needs to be carefully monitored because of its many side effects, and the drug must never be stopped abruptly. Some of the side effects from long-term use include cataracts, high blood pressure, sleep problems, muscle loss, bruising, thinning of the bones (osteoporosis), weight gain and increased risk of infections. For treatment of polymyalgia rheumatica the dose is rapidly decreased to the lowest doses possible. These doses may need to be maintained for some time: anywhere from 18 months to three years. The goal with this and most drugs is to find the lowest effective dose that will avoid as many of the side effects as possible.  

Exercise

Muscles and the other tissues that hold joints together weaken when they aren't moved enough, so the joint loses its shape and function. Exercise may help reduce the pain of polymyalgia and can help you feel better overall. Moderate stretching exercises will help relieve pain and keep the muscles and tendons more flexible and strong. Low-impact exercises like swimming, walking, water aerobics and stationary bicycling can all reduce pain while maintaining strength and flexibility. Always consult a doctor before beginning an exercise program.

Heat/Cold

Heat helps to reduce pain and stiffness by relaxing aching muscles and increasing circulation to the area. There is some concern that heat may worsen the symptoms in an already inflamed joint. Cold helps numb the area by constricting the blood vessels and blocking nerve impulses in the joint. Applying ice or cold packs appears to decrease inflammation and therefore is the method of choice when joints are inflamed.  

Protect Your Muscles and Joints

Protecting your muscles and joints means using them in ways that avoid excess stress. Benefits include less pain and greater ease in doing tasks. Three main techniques to protect your muscles and joints are:

Pacing, by alternating heavy or repeated tasks with easier tasks or breaks, reduces the stress on painful joints and allows weakened muscles to rest.

Positioning muscles and joints wisely helps you use them in ways that avoid extra stress. Use larger, stronger joints to carry loads. For example, use a shoulder bag instead of a hand-held one. Also, avoid keeping the same position for a long period of time.

Using helpful devices, such as canes, luggage carts, grocery carts and reaching aids, can help make daily tasks easier. Using grab bars and shower seats in the bathroom can help you to conserve energy and avoid falls.

By maintaining a healthy weight you also reduce stress on your joints and muscles. If you plan to lose weight, discuss the best program for you with your doctor and a dietitian.

Relaxation

Developing good relaxation and coping skills can give you a greater feeling of control over your arthritis and a more positive outlook.

Polymyalgia rheumatica usually goes away of its own accord, but it is impossible to predict how long the disease will last in any person. Once the pain and stiffness of polymyalgia rheumatica lessen, all patients are encouraged to resume their normal activities, trying to strike a balance between too much activity (which can strain painful muscles), and too little activity (which can increase pain and stiffness) and lead to further weakness.

Giant cell arteritis appears to run its course over a three to five year period with severe pain gradually disappearing. There is also the possibility of loss of vision. However, with treatment, pain subsides and vision loss is rare. The symptoms may recur months or even years after the first episode.

Along with the physical symptoms of arthritis, many people experience feelings of helplessness and depression. Learning daily living strategies to manage your arthritis gives you a greater feeling of control and a more positive outlook. To get the best results, people affected by arthritis need to form close ties with their doctors and therapists, and become full partners in their treatment. From our perspective, it's all part of 'living well with arthritis.' There are several resources you can use in finding out how best to manage your own arthritis. Here are a few:

• The Arthritis Self-Management Program (ASMP) is a unique self-help program offered by The Arthritis Society to help you better control and manage your arthritis.
• The Open Forum within this Web site is an opportunity to discuss and share information with other visitors - people who, through their own experiences, may be able to offer some useful insights.

Of course, there are many other valuable resources for people with arthritis. If you're unclear about where to look for help, be sure to call The Arthritis Society at 1-800-321-1433.