Medical Q&As

Polymyalgia rheumatica - causes?

What causes polymyalgia rheumatica?

The exact cause of polymyalgia rheumatica is not known. It is an arthritic syndrome that results in stiff aching muscles due to inflammation in large joints such as the hips, knees and shoulders. It can also give rise to headache and approximately 15% of cases can be associated with temporal arteritis, which is an inflammatory condition of the temporal artery. This latter condition can cause severe headache and can lead to blindness if it is not diagnosed. Polymyalgia rheumatica predominantly affects older people and usually commences over the age of seventy. The condition can develop within a matter of days but more usually the process begins gradually over several weeks. The condition can cause marked stiffness, which tends to be worst early in the morning and can make it very difficult for the sufferer to get out of bed. Exhaustion due to pain and stiffness is quite common. Some sufferers may exhibit weight loss and some may have slight fever with the condition. Many older people delay seeking help for this condition because they attribute their symptoms to the ageing process. However, persistent pain should never be regarded as a symptom of ageing even though we may stiffen and slow down as we get older. People with polymyalgia usually have a high ESR (erythrocyte sedimentation rate), which is a blood test that indicates if inflammation is present in the body. The ESR is also a useful marker of response to treatment and generally the level falls within a few weeks once the condition is brought under control. Oral steroids are the mainstay of treatment and they usually bring about an improvement of symptoms in a matter of days. Most people are able to discontinue steroids within 6 months to 2 years. In summary polymyalgia rheumatica can be a very disabling condition but fortunately it responds very successfully to steroid therapy and such improvement can often be observed in a matter of days.