Polymyalgia rheumatica (PMR) causes symptoms similar to those of several other conditions, such as rheumatoid arthritis, lupus, and fibromyalgia. For this reason, PMR is sometimes hard to diagnose.
PMR causes widespread muscle and joint stiffness, aching, and pain, with symptoms often worse in the morning or after long periods of inactivity.
It affects both sides of the body equally and may affect the:
- upper arms and shoulders
- neck
- hips
- lower back
- thighs
Other symptoms of PMR include:
- extreme tiredness
- loss of appetite
- weight loss
- fever
- depression
PMR can affect anyone, but it occurs slightly more often in females than males and is more common in white people. The reasons for this are unclear. The average age of onset is 70 years old.
Doctors do not know what causes PMR, but it appears to be driven by inflammation.
PMR typically lasts 1 to 5 years before resolving, though this can vary. People can manage symptoms with medications, exercise, and rest.
Approximately 15% of people with PMR also develop a potentially serious condition known as giant cell arteritis, which causes narrowing or blockages in large blood vessels around the head, neck, and arms.
Symptoms of giant cell arteritis include:
- headaches
- visual difficulties, such as double vision or vision loss
- jaw pain while eating
- scalp tenderness or aching around the temples
Polymyalgia rheumatica shares many symptoms with a range of other diseases, including:
- rheumatoid arthritis (RA)
- tendonitis or bursitis
- infections
- fibromyalgia
- Lyme disease
- spondyloarthropathy
- lupus
- vasculitis
- cancer
Read on to learn about other conditions that can have similar or overlapping symptoms with PMR.
RA is an autoimmune disease in which the immune system attacks the joints. It causes joint pain and stiffness, similar to PMR. People with RA can also experience fatigue, a high temperature, low appetite, and weight loss. Due to these similarities, RA and PMR are often confused.
Additionally, both RA and PMR tend to affect both sides of the body and occur more frequently in older adults. Around 30% of people with PMR have joint swelling and degeneration, which are also symptoms of RA.
However, there are some differences between the symptoms of PMR and RA. Not everyone with PMR develops joint swelling, whereas in RA, it is a key symptom. Additionally, RA often begins in the hands, feet, wrists, and ankles. PMR does not usually affect these joints.
Lupus is another autoimmune condition. However, instead of specifically attacking the joints, the immune system attacks various tissues and organs. The main symptoms are joint and muscle pain, a rash over the nose and cheeks, and extreme fatigue.
Aside from the butterfly-shaped rash on the face, lupus can seem very similar to PMR.
Other symptoms of lupus may include:
- mouth sores
- headaches
- a high temperature
- hair loss
- loss of appetite and weight loss
- skin that is sensitive to the sun
Fibromyalgia is a condition that causes chronic pain across the body. Similar to PMR, it causes muscle stiffness and tension, especially in the morning. It can also cause fatigue.
Other symptoms of fibromyalgia include:
- increased sensitivity to pain
- difficulty sleeping
- difficulty thinking or remembering
- headaches
- digestive symptoms similar to irritable bowel syndrome
A key difference between fibromyalgia and PMR is that fibromyalgia is not inflammatory, so it will not respond to medications that reduce pain by lowering inflammation.
Lyme disease is a bacterial infection transmitted by ticks. It causes joint pain and stiffness, as well as fever and fatigue, much like PMR.
It can also cause:
- a rash around the bite, which may resemble a bull’s-eye
- chills
- swollen lymph nodes
If Lyme disease is left untreated, it can cause more advanced symptoms, such as:
- severe headaches
- neck stiffness
- loss of muscle tone in the face, or facial drooping
- rashes on other areas of the body
- severe arthritis, particularly of the knees or larger joints
- dizziness
- shortness of breath
- heart palpitations
- nerve pain or numbness
- shooting or tingling sensations in the hands and feet
As ticks are tiny, their bites are easy to miss. Additionally, while tests for Lyme disease are available, they are not always accurate.
If Lyme disease is a possibility, a doctor may prescribe antibiotics to treat the infection. If they do not work, it may indicate that Lyme disease is not the cause of the symptoms.
People with cancer can experience some of the symptoms associated with PMR, including fatigue, fever, loss of appetite, and weight loss.
There is also an association between a PMR diagnosis and an increased risk of cancer. A
There is no single test for PMR, which can make diagnosis a challenge. Instead, doctors will begin by:
- asking a person about their symptoms
- taking the person’s medical history
- conducting a physical examination of the affected joints
The next stage of diagnosis may involve blood tests to rule out other conditions, such as lupus and RA.
These tests may include:
CRP and ESR tests check for inflammation in the body, which can be a sign of PMR. If both the ESR and CRP are normal, a doctor is unlikely to diagnose PMR. However, some people with PMR have normal or only slightly raised levels of both.
A doctor may also use an ultrasound or MRI scan to check for bursitis, which is inflammation around the joints.
If a doctor suspects giant cell arteritis, they will also ask about vision changes, jaw and scalp pain, and examine the arteries to see if they are inflamed or tender or have a reduced pulse. They may take a small tissue sample to confirm the diagnosis, but this is not always necessary.
PMR causes widespread pain and stiffness around joints, particularly larger joints like the shoulders. It also causes fever, fatigue, loss of appetite, and weight loss.
These symptoms can be similar to those of other diseases, including RA, lupus, Lyme disease, and fibromyalgia.
A person with symptoms of PMR, or symptoms of diseases that can mimic PMR, should speak with a doctor. This is especially important if they have had a recent tick bite or show signs of giant cell arteritis.
Early treatment can make PMR, as well as other similar conditions, easier to manage.