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Causes
By Mayo Clinic staffThe cause of polymyalgia rheumatica is not well understood. The pain and stiffness result from the activity of inflammatory cells and proteins that are normally a part of your body's disease-fighting immune system.
Inflammation is usually a response to injury or disease, but in some disorders — known collectively as rheumatic diseases — inflammatory activity occurs when there is no apparent need for the response.
In polymyalgia rheumatica, the inflammatory activity seems to be concentrated in tissues surrounding the affected joints. The muscle pain associated with the disorder is called referred pain, or pain that extends from joints to nearby muscles or other tissues.
Multiple causes
Research suggests that a combination of inherited (genetic) factors and external (environmental) factors may contribute to the onset of disease.
- Genetic factors. A gene or genes — not yet identified — may make a person more likely to develop polymyalgia rheumatica. The prevalence of the disorder among people of Northern European ancestry, patterns of family history of the disease and evidence from some genetic studies suggest the influence of inheritance.
- Environmental factors. Certain features of the disorder suggest that an infectious disease may be a contributing factor. For example, the sudden onset of symptoms would be expected from an infectious agent. Also, new cases often appear in cycles in the general population, a factor that would be consistent with the normal cycle of contagious viral diseases. Although studies have produced inconclusive results, several relatively common viral infections have been identified as possible triggers for polymyalgia rheumatica.
Giant cell arteritis
The inflammation-promoting cells and proteins that are active in polymyalgia rheumatica are also active in a disease known as giant cell arteritis. This disorder results in inflammation in the lining of arteries, most often the arteries located in the temples. Giant cell arteritis usually causes headaches, jaw pain, vision impairment and scalp tenderness. It can lead to permanent vision loss.
Polymyalgia rheumatica and giant cell arteritis may, in fact, be variations of the same disease. Studies have produced varying results, but the overlap of diagnoses is significant:
- As many as 20 percent of people with polymyalgia rheumatica may have giant cell arteritis.
- As many as 60 percent of the people with giant cell arteritis may have polymyalgia rheumatica.
- Michet CJ, et al. Polymyalgia rheumatica. BMJ. 2008;336:765.
- Unwin B, et al. Polymyalgia rheumatica and giant cell arteritis. American Family Physician. 2006;74:1547.
- Polymyalgia rheumatica. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/polymyalgiarheumatica.asp. Accessed April 14, 2010.
- Polymyalgia rheumatica. The Merck Manuals: The Merck Manual of Healthcare Professionals. http://www.merck.com/mmpe/sec04/ch033/ch033i.html. Accessed April 6, 2010.
- Salvarani C, et al. Polymyalgia rheumatica and giant-cell arteritis. Lancet. 2008;372:234.
- Giant cell arteritis. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/giantcellarteritis.asp. Accessed April 15, 2010.
- Glucocorticosteroid-induced osteoporosis. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/gi-osteoporosis.asp. Accessed April 15, 2010.
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