Polymyalgia Rheumatica Symptoms: Morning Stiffness, Testing and When to Be Seen

What it involves

MedlinePlus explains that polymyalgia rheumatica is a disorder that causes muscle pain and stiffness in the neck, shoulders and hips. It is most common in women and almost always occurs in people over 50. The cause is unknown, and it sometimes develops overnight and sometimes gradually.

Who this is for

• Adults over 50 with aching shoulders, hips or neck that feel stiffest after resting.
• Patients who struggle to rise from a chair, raise their arms or get dressed in the morning.
• People with new fever, weakness or weight loss along with muscle stiffness.
• Anyone with stiffness plus new headaches, scalp tenderness or vision changes, which need prompt attention.

What to expect

• Questions about when the stiffness is worst, how long it lasts, fever, weight change and your medicines
• An exam of the shoulders, hips and neck, and a check of your temples and scalp
• Blood work, which the practice offers, to look for signs of inflammation
• A referral to a rheumatologist when the picture is unclear or treatment needs specialist oversight

What it can feel like

The stiffness is the hallmark. MedlinePlus describes pain and stiffness in the neck, shoulders and hips that is worst after rest, so mornings and the first minutes after sitting are often the hardest. Some people notice that it began overnight, while for others it creeps in over weeks. Fever, weakness and weight loss can come along with it. Because shoulder and hip aching is common, it is easy to blame age, which is one reason a visit is worthwhile. The shoulder pain guide and the hip pain guide describe other causes of the same areas.

How it is told apart from other problems

Several conditions look similar. Osteoarthritis tends to affect specific joints, while the pattern here is stiffness across the shoulders and hips. Rheumatoid arthritis swells small joints, as the rheumatoid arthritis guide explains. Fibromyalgia causes widespread pain without the same inflammation, covered in the fibromyalgia guide. A provider weighs your age, the timing of the stiffness and your exam, then uses blood work to check for inflammation. Muscle weakness that is the main problem is discussed in the muscle weakness guide.

How it is diagnosed

According to MedlinePlus, there is no specific test for polymyalgia rheumatica. Your provider uses your medical history, your symptoms and a physical exam to make the diagnosis, and lab tests for inflammation may help confirm it. MedlinePlus lists two of these, the erythrocyte sedimentation rate and the C-reactive protein test, both of which are blood tests. Blood work is among the services the practice offers. The complete blood count guide explains another common blood test that is often ordered alongside them.

The link to giant cell arteritis

MedlinePlus notes that polymyalgia rheumatica sometimes occurs along with giant cell arteritis, a condition that causes swelling of the arteries in the head, with headaches and blurred vision as symptoms. That is why new headache, jaw pain, scalp tenderness or any change in vision alongside stiffness should be mentioned right away. The giant cell arteritis guide lists the warning signs and explains why sudden vision loss is an emergency.

Treatment and what to expect

MedlinePlus says doctors often prescribe prednisone, a steroid medicine, and that with treatment the stiffness usually disappears in a day or two. Without treatment it usually goes away after a year or more. Steroid medicines have side effects and need careful follow-up, so never start, change or stop one on your own. A primary care provider can start the work-up and coordinate with a rheumatologist, who is reached by referral rather than in this office.

When to be seen quickly

Make an appointment for stiffness in the shoulders, hips or neck that lasts more than a couple of weeks, especially after 50. Be seen the same day for fever with stiffness, a new headache with tender temples, or pain in the jaw when chewing. Call 911 or go to the ER for sudden vision loss, double vision, or stroke signs such as face drooping, arm weakness or trouble speaking. Same-day visits and walk-ins are welcome at the offices.

Sources

• MedlinePlus: Polymyalgia Rheumatica
• MedlinePlus: Giant Cell Arteritis