Polymyalgia rheumatica and giant cell arteritis

What polymyalgia rheumatica is

Polymyalgia rheumatica is a common inflammatory condition in older adults. Its hallmark is pain and stiffness around the shoulders, neck and hips, usually on both sides, which is typically much worse in the morning and can make simple tasks — getting dressed, rising from a chair, lifting the arms — difficult for at least half an hour or more. The stiffness often eases through the day. People may also feel generally unwell, tired, low in mood, or have a mild fever and lose weight. The exact cause is not fully understood, but it involves inflammation rather than wear and tear. PMR usually responds well and quite quickly to anti-inflammatory steroid treatment, which is one of the clues doctors use to support the diagnosis. It is not the same as ordinary muscle aches or arthritis.

What giant cell arteritis is

Giant cell arteritis, sometimes called temporal arteritis, is inflammation of the walls of medium and large arteries, most often those around the head and scalp. This swelling can narrow the vessels and reduce blood flow. Warning signs include a new, often severe headache, tenderness of the scalp (for example when combing the hair), pain in the jaw when chewing, and feeling generally unwell. The most serious risk is to the eyes: if the artery supplying the eye is affected, it can cause sudden loss of vision, which may become permanent. GCA is closely related to PMR — some people have both — and shares the same underlying inflammatory process. Because of the threat to sight, GCA is treated as a medical emergency and must not be delayed.

Giant cell arteritis is an emergency

This is the most important message. GCA can cause sudden, permanent blindness if not treated quickly, so it needs same-day medical assessment and treatment — do not wait. See a doctor urgently, through your GP or NHS 111, if you are over 50 and develop a new severe headache, scalp tenderness, jaw pain on chewing, or feel generally unwell, especially alongside PMR symptoms. Seek emergency care and call 999 or go to A&E if you have any sudden change in vision — blurring, double vision, a curtain across your sight, or loss of vision in one or both eyes. Treatment is usually started straight away, often before all tests are complete, precisely because acting fast is what protects your sight. Never dismiss a new headache with visual symptoms in this age group.

How they are diagnosed and treated

Diagnosis rests on the pattern of symptoms, an examination, and blood tests that measure inflammation, which are usually raised in both conditions. For suspected GCA, doctors may arrange further tests such as an ultrasound of the temporal arteries or a small sample (biopsy) of the artery, but treatment is started immediately when GCA is likely, without waiting for results. Both conditions are treated with steroid medicines that reduce inflammation; the dose is higher for GCA because of the risk to sight. Treatment is then slowly reduced over many months, guided by symptoms and blood tests, and stopping too soon can allow a flare. Some people need additional medicines to help control the condition or protect against steroid side effects, arranged by the specialist team.

Living with PMR and GCA

Most people improve greatly once treatment starts, often within days for PMR. Because treatment lasts many months and sometimes longer, it is important not to stop steroids suddenly, to attend follow-up appointments, and to have blood tests as advised. Long courses of steroids can have side effects, so your team may recommend measures to protect the bones and monitor blood pressure and blood sugar; carry a steroid treatment card so other health professionals know you are taking them. Watch for a return of symptoms during dose reductions, and report any new visual symptoms or severe headache at once. With careful, monitored treatment, both conditions can usually be well controlled, and many people eventually come off treatment. Stay in touch with your GP or rheumatology team throughout.