Overview
Diagnosis
A physical exam along with laboratory tests can help your healthcare professional determine the cause of pain and stiffness. The evaluation often includes checking the joints and the nervous system in a neurological exam. During this process, your healthcare professional may gently move your head, arms and legs to assess the range of motion and identify areas of discomfort.
A diagnosis may change over time. Some people initially diagnosed with polymyalgia rheumatica later go on to be diagnosed with rheumatoid arthritis or giant cell arteritis as symptoms evolve.
Tests you may have include:
• Blood tests to check complete blood counts and markers of inflammation, such as erythrocyte sedimentation rate and C-reactive protein
• Imaging tests, such as ultrasound, MRI or PET scan, to look for inflammation or identify other causes of joint pain
Watching for giant cell arteritis
Your healthcare professional also monitors you for symptoms that may suggest giant cell arteritis. Seek medical advice promptly if you experience:
• New or persistent headaches
• Jaw pain or tenderness
• Blurred vision, double vision or vision loss
• Scalp tenderness
To confirm giant cell arteritis, you may need an ultrasound or a biopsy of a temple artery. During the biopsy, a small sample of the artery is removed under local numbing medicine and examined under a microscope.
More information
C-reactive protein test
Neurological examinations
Sed rate
Ultrasound
Treatment
Treatment usually includes medicines that help ease symptoms, although it’s common for the condition to return over time.
Medications
Corticosteroids such as prednisone are the most common treatment for polymyalgia rheumatica. Many people feel significant relief within a few days. After a few weeks, your healthcare professional may slowly reduce the dose based on symptoms and blood test results. The aim is to use the lowest effective dose to prevent symptoms from returning.
Long-term corticosteroid use can cause side effects, including weight gain, bone thinning, high blood pressure, diabetes and cataracts. Your healthcare team will monitor you closely and adjust treatment if needed. Additional medicines may be used to manage side effects.
Calcium and vitamin D supplements may be recommended to help prevent bone loss. Guidelines suggest 1,000 to 1,200 milligrams of calcium and 600 to 800 international units of vitamin D daily for anyone taking corticosteroids for three months or longer.
Methotrexate may be used along with corticosteroids to reduce the steroid dose or treat relapses. It is taken by mouth and helps lower the immune system’s activity. It may be used early in treatment or added later if symptoms return.
Sarilumab may be an option for people whose symptoms recur. This medicine blocks a substance in the body that triggers inflammation. It is taken as an injection every two weeks and can help reduce symptoms with lower doses of corticosteroids.
Physical therapy
Most people who take corticosteroids return to their previous activity levels. If your activity has been limited, physical therapy may help rebuild strength and mobility. Your healthcare team can guide you on whether physical therapy is a suitable option.
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