What Is Polymyalgia Rheumatica and Is It Related to Fibromyalgia?

Here’s a quick language lesson: “Myalgia,” the second half of “fibromyalgia,” comes from the combination of two Greek combining forms¹. The first is “myo,” which means muscle². The second, a variation on “algo,” “algia,” means pain³. Muscle pain is a hallmark of fibromyalgia, but it’s not the only chronic illness that’s named after it’s primary symptom. Take for example, polymyalgia — a condition that may sound similar to fibromyalgia, but has little in common with it.

What is Fibromyalgia?
What Are Common Fibromyalgia Symptoms?

What Is Polymyalgia?

“Polymyalgia rheumatic is an inflammatory condition that causes pain and stiffness primarily involving the shoulder and hip girdles,” Paul Sufka, M.D., a board-certified rheumatologist, told The Mighty. “We don’t know what causes the condition, but it is seen almost exclusively in adults over the age of 50.”

Polymyalgia rheumatica (PMR) is believed to be an autoimmune condition that causes your immune system to attack your connective tissues⁴. It typically can be treated effectively with low-dose steroids and has a good prognosis. Unlike fibromyalgia, which is still a relatively controversial diagnosis, there is at least 100 years of medical knowledge behind how to manage polymyalgia¹.

What Causes Polymyalgia?

The cause of polymyalgia is still a mystery to experts. What we do know is the symptoms may be directly related to the inflammation the condition causes in your muscles⁴. Beyond that, Dr. Sufka said research suggests polymyalgia may be caused by a combination of genetics and environmental factors, especially infection^{5, 7}. Other evidence suggests polymyalgia might be related to immune system issues or aging in general⁶.

Who Gets Polymyalgia?

Polymyalgia may be caused in part by aging since most people who experience polymyalgia are between 70 and 80 years old, and occurs in almost no one under the age of 50¹. Polymyalgia affects approximately 50 out of every 100,000 people over the age of 50 worldwide⁷. Similar to fibromyalgia, polymyalgia is more common in women¹. Caucasian people, especially in Northern European and Scandinavian countries or with Viking ancestry are also most likely to develop polymyalgia⁷.

What Are the Symptoms of Polymyalgia?

The core symptoms of polymyalgia include stiffness and pain in your neck, shoulder and hip muscles⁴. Most people with polymyalgia, about 70 to 95% of patients, will notice stiffness and pain in their shoulder muscles first, which then gradually moves to your neck and hip areas on both sides of your body^{7, 10}. Your symptoms may have a rapid onset and seem to come on out of the blue — you were previously healthy but over a period of two weeks or less found pain and stiffness limit your agility⁷.

Approximately 40% of people will experience additional polymyalgia symptoms, including^{4, 10}:

Low-grade fever
Flu-like symptoms
Weakness
Weight loss

With polymyalgia, it’s common to experience difficult stiffness right after you wake up, which can make some activities like putting on your socks and shoes very difficult^{7, 8}. You may also experience stiffness during the day if you’ve been sitting for a long period of time, but once you get moving, you can typically go about your usual routine⁷. Raising your arms above your shoulders is also a common difficulty with polymyalgia because it can impact your upper arms⁸.

Many people who have polymyalgia are at risk for experiencing depression, which may be your first true symptom of the condition before you notice the pain⁷. This can be exacerbated because developing polymyalgia symptoms suddenly can be scary — you might fear you’ll no longer be able to do the activities you enjoy or have anxiety about aging⁷. Polymyalgia can worsen your other chronic illness symptoms because of how it affects your system.

Polymyalgia rheumatica causes muscle pain and stiffness in the neck, shoulder, and hip. Stiffness is most noticeable in the morning or after resting. https://t.co/EUrJfZXYrX #polymyalgia pic.twitter.com/sUEXGtE7m8

— NIAMS/NIH/DHHS (@NIH_NIAMS) October 17, 2019

How Is Polymyalgia Diagnosed?

There isn’t a single test that can detect polymyalgia, so your doctor will make a diagnosis based on your symptoms, family medical history, a physical examination and blood tests to measure the level of inflammation in your body and to rule out other potential conditions⁹. Because polymyalgia is an autoimmune disease and the pain symptoms can look similar to other chronic illnesses, like rheumatoid arthritis or fibromyalgia, ruling out other possibilities is important⁸.

While no blood test can definitely determine you have polymyalgia, your doctor will likely order want to determine if you have higher than expected levels of inflammation, a reliable sign you may have polymyalgia^{5, 7, 8}. “In most cases, if inflammatory markers are normal, the patient is unlikely to have polymyalgia rheumatica,” said Sufka.

For example, your doctor might order an erythrocyte sedimentation rate (ESR) or “sed rate” test, a blood test that measures inflammation in your body by looking at how fast your red blood cells settle at the bottom of a test tube^{8, 11}. A blood test can also measure your C-reactive protein (CRP) levels, a protein made by your liver, which can also indicate higher levels of inflammation.

How Is Polymyalgia Treated?

The good news is polymyalgia is a very treatable condition by reducing your inflammation^{4, 5}. For most patients with a polymyalgia diagnosis, this means prescription corticosteroids, particularly prednisone^{4, 5, 8}. With medication, you may see a major improvement in your polymyalgia symptoms in just a few days. If after two to three weeks on the medication you don’t get better, it’s likely you don’t have polymyalgia but another condition⁸.

“Most people who develop polymyalgia rheumatica are initially treated with corticosteroids — usually prednisone starting at moderate doses of around 15 or 20 mg per day — and then slowly tapered over several months,” said Sufka. “Most patients have a rapid improvement of their symptoms once prednisone is started.”

Though corticosteroids are extremely effective, medications like prednisone have some pretty serious side effects that occur in at least 50% of patients, such as irritability and mood swings, facial swelling (or “moon face“), weight gain or hot flashes^{10, 12}. You won’t need to take the corticosteroids for the rest of your life, however^{8, 10}. Your doctor should find the lowest dose of the medication to manage your symptoms and most patients can stop taking corticosteroids after one to three years, depending on the severity of your symptoms⁸.

Depending on the course of your illness, there’s also a chance your polymyalgia symptoms can relapse. Sufka said relapse occurs in about 50% of patients^{5, 10}. Research suggests that patients who experience a relapse were more likely to have started treatment on higher doses of corticosteroids or faster medication tapers at the end of treatment¹⁰. Sufka said newer research suggests the “immunosuppressive medication methotrexate” can also be used to treat polymyalgia and prevent relapses⁵.

What’s the Difference Between Polymyalgia and Fibromyalgia?

Apart from their name and main symptom, fibromyalgia and polymyalgia have little in common. Even the muscle pain might be slightly different — some experts suggest polymyalgia muscle pain doesn’t include the tenderness you may experience with fibromyalgia muscle pain¹⁵. The way each condition affects your body is very distinct and the treatment methods are also very different^{5, 13, 14}.

“Sometimes differentiating these two conditions can be difficult, especially because there isn’t an extremely specific blood test for polymyalgia rheumatica, and there isn’t a blood test for fibromyalgia,” said Sufka, adding:

The main difference is that polymyalgia rheumatica is an inflammatory condition, and fibromyalgia is a non-inflammatory condition. Because of this, polymyalgia rheumatica responds to treatment with anti-inflammatory medications. … Alternatively, fibromyalgia is a non-inflammatory condition caused by the nervous system that results in pain amplification, and is associated with fatigue, ‘brain fog’ and sleep problems.

While it’s possible to have polymyalgia and fibromyalgia at the same time, the bigger risk when you’re diagnosed with polymyalgia is developing another inflammatory condition called giant cell arteritis.

Polymyalgia rheumatica gives muscle PAIN without TENDERNESS.
Fibromyalgia and statin induced myositis is associated with tenderness. Fibromyalgia has very severe SLEEP DISTURBANCE

— Conrad Fischer (@SeeFisch) July 23, 2019

What Is Giant Cell Arteritis?

“Giant cell arteritis (GCA) is another inflammatory condition that causes inflammation of the large blood vessels, most frequently affecting the head and scalp,” Sufka said. “The most common symptom of GCA is headache, as well as jaw pain that worsens with chewing, tenderness when touching the scalp over the temples. In some cases, GCA affects the arteries going to the eyes, which can result in blindness.”

Approximately 10 to 20% of people diagnosed with polymyalgia will develop GCA^{7, 10}. About 40 to 60% of people diagnosed with GCA have polymyalgia, though polymyalgia is two-thirds more common¹⁰.

The reason that polymyalgia and GCA are linked is unclear, but some experts believe both illnesses could be related to similar genes and may be different ways the same disease process manifests⁷. You can develop GCA before, during or after your polymyalgia diagnosis¹⁰. GCA is a serious condition that your doctor should monitor for regularly if you have polymyalgia¹⁰.

Our #longread for the #weekend: Giant cell arteritis and polymyalgia rheumatica: current challenges and opportunities
Read it for #free here https://t.co/ploWrPdIzF #SharedIt pic.twitter.com/oLfSULffsb

— NatRevRheumatol (@NatRevRheumatol) November 3, 2018

If you’re concerned about your pain symptoms, check with your doctor. Even if you’re diagnosed with fibromyalgia — and have a hard time finding ways to manage your symptoms — know there are many treatment options out there to help with chronic pain, fatigue and your other fibro symptoms. To learn more, check out The Mighty’s Guide to Fibromyalgia, and post on The Mighty using the hashtag #Fibromyalgia to connect with others who have been there.

You can also check out these other Mighty stories that have helped others dealing with chronic illness and chronic pain:

Sources

Tsai, Y. (2018). PAIN MANAGEMENT: Polymyalgia and fibromyalgia are different. The Daytona Beach News-Journal. Retrieved from: https://www.news-journalonline.com/entertainmentlife/20181231/pain-management-polymyalgia-and-fibromyalgia–are-different
Dictionary.com. (2002). Myo-. Retrieved from https://www.dictionary.com/browse/myo-.
Dictionary.com. (2002). Algia. Retrieved from https://www.dictionary.com/browse/algia?s=t.
Clauw, D. (n.d.). Difference Between Fibromyalgia and Polymyalgia. Retrieved from https://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/fibromyalgia-questions/polymyalgia-fibromyalgia.php.
Sufka, Paul. (2019). What is polymyalgia versus fibromyalgia? [Email interview].
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2016). Polymyalgia Rheumatica: Causes. Retrieved from https://www.niams.nih.gov/health-topics/polymyalgia-rheumatica#tab-causes.
Milchert , M., & Brzosko, M. (2017). Diagnosis of polymyalgia rheumatica usually means a favourable outcome for your patient. Indian Journal of Medical Research, 145(5), 593–600. doi: 10.4103/ijmr.IJMR_298_17
Sufka, P. (2019). Polymyalgia Rheumatica. Retrieved from https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Polymyalgia-Rheumatica.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2016). Polymyalgia Rheumatica: Diagnosis. Retrieved from https://www.niams.nih.gov/health-topics/polymyalgia-rheumatica#tab-diagnosis
Salvarani, C. G., Cantini, F. G., & Hunder, G. G. (2008). Polymyalgia rheumatica and giant-cell arteritis. The Lancet Seminar, 372(9634), 234–245. doi: 10.1016/S0140-6736(08)61077-6
U.S. National Library of Medicine. (n.d.). Erythrocyte Sedimentation Rate (ESR): MedlinePlus Lab Test Information. Retrieved from https://medlineplus.gov/lab-tests/erythrocyte-sedimentation-rate-esr/.
Wyant, P. (2018, November 16). 15 ‘Embarrassing’ Side Effects of Prednisone We Don’t Talk About. Retrieved from https://themighty.com/2018/11/embarrassing-prednisone-side-effects/.
The Mighty. (2019, April 1). What Is Fibromyalgia? Retrieved from https://themighty.com/2019/04/what-is-fibromyalgia/.
Matsumoto, A. (2007, April 24). Polymyalgia and Fibromyalgia. Retrieved from https://www.hopkinsarthritis.org/ask-the-expert/polymyalgia-and-fibromyalgia-2/
Fischer, C. [SeeFisch]. (2019, July 22). Polymyalgia rheumatica gives muscle PAIN without TENDERNESS. Fibromyalgia and statin induced myositis is associated with tenderness. Fibromyalgia has very severe SLEEP DISTURBANCE [Tweet]. Retrieved from https://twitter.com/SeeFisch/status/1153468637770080261

Polymyalgia Rheumatica