Stiff, achy joints and fatigue? What you need to know about polymyalgia rheumatica

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As you age, you may think joint aches and pains or feeling tired are just normal parts of getting older. While that can be true, it is not always the case. If you find it harder to get up in the morning, and you can't do many of the everyday tasks you used to do comfortably, you could have a common condition called polymyalgia rheumatica (PMR).

Here are important facts about the disease you should know, and signs to watch for.

1. What is PMR?

PMR is a common inflammatory rheumatic disease and is the second most common rheumatic disease after rheumatoid arthritis.[1] Rheumatic diseases cause the body's immune system to attack joints, muscles, bones and organs.[2]

PMR starts in the large joints including the shoulders, hips and neck. People aged 50 years or older have a greater risk of developing PMR, and women are two to three times more likely to be affected than men.[3]

2. Typical PMR symptoms

Common symptoms of PMR[3] to watch for include:

• Joint swelling
• Morning stiffness
• Weakness
• Loss of appetite
• Weight loss
• Mild fever
• Fatigue

3. How PMR disrupts daily life

The symptoms of PMR, especially the associated pain, can be debilitating and may disrupt everyday life. Sleep interruptions can make you feel tired during the day, and for many people, the pain and stiffness can feel worse in the morning.[4]

PMR can also make everyday activities like walking, showering, brushing your hair or teeth, or even rolling over in bed feel much more difficult.

4. Diagnosing PMR

Because its symptoms overlap with many other age-related conditions, PMR can be difficult to diagnose, requiring rheumatologists to assess a variety of factors to confirm it.[5]

These factors may include:

• your specific symptoms
• a physical examination
• imaging of the affected joints, such as hips and shoulders
• blood tests to determine your inflammation markers

"Patients as young as 50 years old through their 80s or 90s come in to see us saying, 'I'm having shoulder pain,' or 'I haven't been able to get out of bed,'" says board-certified rheumatologist Puja Chitkara, M.D. "Their pain may be attributed to arthritis or rotator cuff disease, but that may not be what's really going on."

When you have PMR, your immune system isn't working as it should. Your body thinks it's under attack and tries to fend off the attack with inflammatory proteins. Through a blood test, doctors can detect a protein called interleukin-6, or IL-6, a common protein seen in patients with PMR.[1] High levels of IL-6 can cause pain, stiffness and fatigue.

5. Discussing symptoms with your doctor

Clearly describing all of the symptoms you're experiencing will help your doctor to identify the underlying cause.

"One of the biggest hurdles to correctly diagnosing PMR is underreporting of symptoms," says Chitkara. "When the disease first starts, a lot of patients may say, 'Oh, this could just be arthritis,' or downplay their fatigue and other symptoms."

Many people with PMR may have other concurrent conditions that can complicate both their diagnosis and best course of treatment. This makes it even more important for people experiencing symptoms associated with PMR to be thorough when discussing their condition with members of their healthcare team.

Consider keeping a journal of your symptoms so you can report them to your healthcare provider more accurately. For example, note the length of time you've experienced your symptoms, when they occur and how these symptoms affect your daily activities. It may also be helpful to keep a record of how much pain you're experiencing day to day.

6. Treating PMR

The first line of treatment for PMR is an oral glucocorticoids (GCs),[1] such as prednisone, which is a type of corticosteroid. Low to moderate dosages of GCs can help relieve PMR symptoms. Steroids may reduce the inflammation that causes pain and stiffness. As you start to feel better, your doctor will slowly lower your dose of steroids over time.

"Because long-term use of steroids can be associated with many side effects such as osteoporosis, cataracts and diabetes, we like to slowly taper patients off of steroids and consider steroid sparing advanced treatments early in the disease course if they are unable to taper or have other associated conditions," explains Chitkara.

If you're still experiencing persistent pain and stiffness, ask your doctor if adding another treatment option to your treatment plan could help control your symptoms.

In addition to medications, many people with PMR find that lifestyle modifications can help improve symptoms[4] and daily functioning.

"Your healthcare team may provide additional support including appropriate exercise, physical therapy and nutrition guidance tailored to your individual needs," adds Chitkara.

7. Learn more about PMR

If you have pain and stiffness in your hips, shoulders and neck, your primary care doctor may suspect PMR. Ask if you need a referral to see a rheumatologist, who will test you for PMR and prescribe treatment. If you've been diagnosed with PMR, your doctor will help you to find a treatment plan that's right for you.

Visit PMRAndYou.com to learn more about polymyalgia rheumatica symptoms, diagnosis, support and treatment options.