What is Polymyalgia Rheumatica and Temporal (Giant Cell) Arteritis

Polymyalgia rheumatica (PMR) and Giant Cell arteritis (GCA) are closely related systemic disorders of an unknown cause that affect mainly elderly people1,3,4. These conditions may occur independently or may occur in the same patient, either together or at different times. 15-50% of patients with polymyalgia rheumatica also have giant cell arteritis4. Both disorders are treated with steroid medications. PMR is an inflammatory disorder that causes sudden onset of pain and stiffness in the shoulder, neck, hips and lumbar spine1,3,4. GCA is a granulomatous inflammatory disorder of the large arteries, commonly causing a severe headache, tenderness of the scalp or temple, pain in the jaw when eating, and systemic symptoms such as severe fatigue, malaise and fever1,3,4.

Statistics on Polymyalgia Rheumatica and Temporal (Giant Cell) Arteritis

Both giant cell arteritis and PMR are rare in people younger than middle-aged. Incidence rises with age and both conditions tend to be more common in women. There also appears to be a geographic distribution of the disease, with the highest rates of PMR found in Northern Europeans.

Risk Factors for Polymyalgia Rheumatica and Temporal (Giant Cell) Arteritis

The cause of polymyalgia rheumatica is still unknown. It is thought that the disorder is caused by an immune response triggered by an infection in people who are genetically predisposed to developing the condition.

Progression of Polymyalgia Rheumatica and Temporal (Giant Cell) Arteritis

The natural history of PMR is not well understood as most patients are diagnosed and treated. It is thought that even untreated, this condition will resolve in 1-5 years. PMR is not associated with the development of serious complications. Patients with GCA may develop complications such as painless temporary or permanent loss of vision or even a stroke in severe cases.

How is Polymyalgia Rheumatica and Temporal (Giant Cell) Arteritis Diagnosed?

Diagnosis is usually based on exclusion of other diseases which might cause the same symptoms, such as thyroid disease, malignant disease, rheumatoid arthritis, infection and connective tissue diseases.
Investigations such as blood tests and x-rays may help to narrow down the diagnosis.

Prognosis of Polymyalgia Rheumatica and Temporal (Giant Cell) Arteritis

The prognosis of treated PMR is excellent. However relapses may occur in 25% of patients, and every patient diagnosed with PMR is at risk of developing giant cell arteritis at a later stage. As steroid medications are the mainstay of treatment, long term effects of treatment need to be considered.

How is Polymyalgia Rheumatica and Temporal (Giant Cell) Arteritis Treated?

Steroid medications are the treatment of choice and can dramatically reduce symptoms of PMR and GCA within 24-48 hours of starting.

Polymyalgia Rheumatica and Temporal (Giant Cell) Arteritis References

[1] Apley G. Concise system of orthopaedics and fractures. 2nd ed. 2001, Arnold
[2] Collier, Longmore, Scally. Oxford handbook of clinical specialties, 6th ed. 2003, Oxford University Press.
[3] Kumar and Clark. Clinical Medicine 5th ed. 2002. WB Saunders
[4] Meskimen, Cook, Blake. Management of Giant Cell Arteritis and Polymyalgia Rheumatica. Am F Phys, 2000. (online) http://www.aafp.org/afp/20000401/2061.html
[5] Pountain, Hazleman. ABC of Rheumatology: Polymyalgia rheumatica and Giant cell arteritis. BMJ 1995;310:1057-1059.
[6] Swannell A. Fortnightly review: Polymyalgia rheumatica and temporal arteritis: diagnosis and management. BMJ 1997;314:1329.