Polymyalgia Rheumatica And Giant Cell Arteritis

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Topic Overview

What are polymyalgia rheumatica and giant cell arteritis?

Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are inflammatory conditions that often occur together or one after the other. The inflammation in polymyalgia rheumatica affects joints and surrounding areas, especially those joints found in the hip, neck, and shoulders. The inflammation in giant cell arteritis affects the blood vessels that carry blood up through the neck to the head (carotid arteries), especially those that carry blood to the eyes, jaw, and temple (temporal arteries).

Experts believe that the two conditions are related.^{1, 2}

• The two conditions can occur before or after each other or at the same time.
• About half of people with giant cell arteritis also have symptoms of polymyalgia rheumatica.
• People with polymyalgia rheumatica can also have giant cell arteritis.

Giant cell arteritis is also known as temporal arteritis or cranial arteritis. It can be more serious than polymyalgia rheumatica because it may result in loss of vision and may lead to stroke or mini-strokes (transient ischemic attacks, or TIAs). People who have this condition need prompt treatment.

Polymyalgia rheumatica and giant cell arteritis are discussed together because they often occur together and affect similar groups of people.

What causes polymyalgia rheumatica and giant cell arteritis?

Experts do not completely understand the cause of polymyalgia rheumatica and giant cell arteritis. It may be that the body's immune system is attacking its own tissues. This is known as an autoimmune response. Your genes may play a role in an autoimmune response. People of Scandinavian or Northern European descent develop polymyalgia rheumatica or giant cell arteritis more often than do those of southern European, Asian, or African ancestry.^{2, 3}

What are the symptoms?

Polymyalgia rheumatica causes muscle pain and morning stiffness and may cause fever, weight loss, and fatigue. Pain and stiffness usually occur in the neck, shoulders, or hip area.

Giant cell arteritis may cause pain and/or aching of the jaw, severe headache, tenderness of the scalp, and vision problems. Untreated giant cell arteritis can cause permanent blindness, stroke, or mini-strokes.

How are polymyalgia rheumatica and giant cell arteritis diagnosed?

Your doctor will do a physical exam and ask you about your past health and symptoms. Because the symptoms of polymyalgia rheumatica are similar to arthritis, he or she will rule out this condition. Your doctor may suggest blood tests to obtain more information if he or she thinks you may have either condition. To diagnose giant cell arteritis, a surgeon may take a sample of a blood vessel on your temple and test it for inflammation (temporal artery biopsy).

How are they treated?

Your doctor will use corticosteroid medicine to treat polymyalgia rheumatica and giant cell arteritis. After treatment begins, symptoms usually improve quickly and go away in 2 to 4 weeks. After this, most people need to take corticosteroid medicine for 1 to 2 years or sometimes longer. This helps to control symptoms and to prevent the conditions from returning.

Corticosteroids decrease calcium in the body. Calcium is important for keeping your bones strong. Because of this, you need to take measures to prevent bone thinning (osteoporosis). This includes getting enough calcium and vitamin D and exercising to strengthen bones. Your doctor may also give you a medicine to prevent bone thinning, such as alendronate or risedronate.

Who gets polymyalgia rheumatica and giant cell arteritis?

Polymyalgia rheumatica and giant cell arteritis hardly ever occur in people younger than 50, and they are unusual in people younger than 60. Polymyalgia rheumatica is the more common of the two conditions. Giant cell arteritis is the more dangerous, because it sometimes leads to serious complications, such as a loss of vision or stroke.

The average age at which giant cell arteritis occurs is about 70, and women account for up to 80% of all giant cell arteritis cases.³

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Last updated:	May 08, 2007
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	E. Gregory Thompson, MD - Internal Medicine, Stanford M. Shoor, MD - Rheumatology
Editors:	Kathe Gallagher, MSW, Pat Truman