Polymyalgia Rheumatica Symptoms, Causes and Natural Remedies

Polymyalgia rheumatica causes stiffness in the shoulders, neck and hips, especially in the morning or after a long rest. It almost exclusively affects adults 50 and older, with the average age of diagnosis around 70. The condition has no known cause, but it responds very well to simple medical treatment. In addition, there are natural remedies you can use to help ease stiffness and relieve muscle pain and other symptoms caused by polymyalgia rheumatica.

What Is Polymyalgia Rheumatica?

Polymyalgia rheumatica is a condition that causes pain and stiffness in the shoulders, neck, lower back and hips. In some cases it may also cause pain and stiffness in the hands or wrists. The pain and stiffness are the worst in the morning or after long periods of rest, such as long car rides or a nap on the couch. The stiffness can be so severe that it limits movement, preventing people with polymyalgia rheumatica from bending over to put on their shoes, or from lifting their hands above their heads to pull on a shirt.

Inflammation is often present in the joints, but the disease has no known cause. It is diagnosed via a physical exam from a doctor as well as blood tests to check for inflammation. These tests often include a check for erythrocyte sedimentation rate (the “sed” rate, or ESR) and C-reactive protein (CRP). Both are usually high in people with polymyalgia rheumatica, but a rheumatologist may also be able to diagnose the condition in people without very high sed rates or CRP levels.

Polymyalgia rheumatica usually starts fairly suddenly — as quickly as overnight in some cases, but more often over the course of several days or weeks. The condition is particularly common among people who also have giant cell arteritis, also known as GCA or temporal arteritis. This condition involves swelling (inflammation) of large blood vessels, particularly in the head, neck and shoulders.

What is the difference between fibromyalgia and polymyalgia rheumatica?

Some people mistake the symptoms of polymyalgia rheumatica with those of fibromyalgia, since both conditions can cause muscle pain, stiffness and fatigue. However, fibromyalgia pain is typically more severe, and it affects more muscles and joints of the body than polymyalgia rheumatica. It can also affect memory, sleep, toileting and other aspects of life that polymyalgia rheumatica usually doesn’t impact. In addition, inflammation doesn’t play a role in fibromyalgia. Because of the different treatment approaches for the two diseases, a healthcare professional should make the diagnosis. (1)

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Polymyalgia Rheumatica Signs and Symptoms

In most cases, the signs and symptoms of polymyalgia rheumatica are consistent and include:

• Pain and stiffness that is worst in the morning or after resting but gets better after activity, or as the day goes on
• Painful and stiff shoulders, upper arms, neck, back, buttocks, thighs or hips
• Both sides of the body affected by the pain and stiffness, rather than just one shoulder or hip
• Pain or stiffness in the elbows and wrists, in some cases
• Difficulty moving the arms or affected areas through the full range of motion

Some people may also experience more general symptoms, such as:

• Slight fever
• Fatigue
• Weight loss or loss of appetite
• A general unwell feeling
• Depression

People who have giant cell arteritis or temporal arteritis may have other symptoms at the same time, such as headaches, vision changes, throbbing or warm scalp and soreness in the jaw. Temporal arteritis can lead to serious complications and should be treated immediately.

Polymyalgia Rheumatica Causes and Risk Factors

Polymyalgia rheumatica causes are unknown. Because it can come on quickly and is more likely during certain times of the year, some people believe it may be caused by an infection, such as a virus. However, no virus has been found. Some also believe it may be an autoimmune disorder. Muscle tissue samples (biopsies) in people with polymyalgia rheumatica appear normal and healthy in most cases. The inflammation in nearby joints appears to cause the muscle pain and stiffness.

Risk factors for polymyalgia rheumatica include: (2)

• Older age — Most people with the disease are between 70 and 80 years old, but it affects adults 50 and older.
• Genetics — People with certain genes may be more likely to develop the condition.
• Sex — Women are twice as likely as men to develop polymyalgia rheumatica.
• White race — Caucasians of Scandinavian or northern European descent are most likely to develop the condition.

Conventional Treatment

Without treatment, polymyalgia rheumatica usually lasts for a year or more. Thankfully, it eventually does go away on its own. However, the pain and stiffness can be so severe or disruptive that many people seek treatment.

With treatment — usually low-dose steroids such as prednisone — polymyalgia rheumatica symptoms may disappear in just a dose or two. Most people see a very noticeable improvement within the first few days to weeks of treatment. However, it may require several months or even a year or more of steroid treatment to keep symptoms at bay. Polymyalgia rheumatica treatment usually changes over time, with gradual lowering of the steroid dose to find out whether symptoms will return.

Unfortunately, many people trade the symptoms of polymyalgia rheumatica for side effects of steroid treatment, which may include weight gain, changes in blood sugar control, decreased bone density and many other problems.

Symptoms do not usually respond to treatment with over-the-counter, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

5 Natural Remedies for Polymyalgia Rheumatica Symptoms

There are no known natural cures or quick diet fixes for polymyalgia rheumatica. However, there are ways you can manage your diet and activities to optimize your health. In addition, you can take steps to naturally manage side effects you may experience from medical treatment, or symptoms from related health conditions.

1. Try an anti-inflammatory diet

Inflammation is closely linked with the current understanding of polymyalgia rheumatica. Inflammation in the joints appears to cause radiating pain and stiffness in the nearby muscles. Following an anti-inflammatory diet has not been proven to impact polymyalgia rheumatica or its symptoms, but many healthcare professionals support it as a simple way you can give your body extra tools for fighting inflammation. You may also notice that certain foods seem to ease or worsen your symptoms. This can help you build your own “polymyalgia rheumatica diet” to your needs. Please note that if you have other conditions, such as diabetes or heart disease, your diet may need to differ. Consider these anti-inflammatory diet tips for your polymyalgia rheumatica: (3, 4, 5)

• Consume healthy fats. These include the healthy omega-3 fatty acids found in walnuts, flax, salmon and other fatty fish, fish oil supplements, coconut oil, eggs and more.
• Eat a wide variety of fruits and vegetables. This is a key tip for many disease-fighting diets. A range of fruits and vegetables supply you with a broad number of nutrients as well as fiber, antioxidants and more. Prepare them healthfully, either by eating them fresh or by baking, steaming, adding them to salads or using only healthy dips or dressings for them. Avoid frying in lots of oil or drenching them in fatty or sugary sauces. Champion anti-inflammatory fruits and veggies include leafy greens, bok choy, celery, beets, broccoli, blueberries and pineapple.
• Stick with whole grains. Oats, brown rice, corn, quinoa and more whole grains may lower the CRP level in the blood, which is an indicator of inflammation. Refined grains and sugars have been linked to increased inflammation.
• Stay hydrated. Proper hydration can help your body combat inflammation. Aim to drink two to three liters of water per day. Decaffeinated or herbal teas also offer great ways to stay hydrated.
• Avoid inflammatory foods. These include many processed meats, foods with added sugar or white flour, pastries, margarine, fried foods and red meat. You should also avoid any foods to which you have a sensitivity and any that appear to worsen your symptoms.

2. Get plenty of calcium and vitamin D

Not only does the risk for osteoporosis increase with age, but polymyalgia rheumatica medical treatment (with steroids) can also weaken the bones. Fight bone loss by getting plenty of calcium and vitamin D in your diet or through supplements.

• Try foods high in calcium, such as:
  • Canned, bone-in fish (such as sardines)
  • Yogurt, milk or other dairy products
  • Leafy greens
  • Almonds
• Eat foods high in vitamin D, such as:
  • Eggs
  • Fatty fish or fish oil
  • Fortified milk or juice
  • Beef liver
  • Fortified cereals
  • Mushrooms
  • Note: You can also get vitamin D from the sun.
• Through a combination of diet and supplements, adults aged 51 and over should aim for: (6)
  • 1000–1200 milligrams of calcium per day (Some adults may need more depending on their steroid use or other risk factors.)
  • 600–800 IUs of vitamin D per day (Again, some adults may require more.)
• Consult your polymyalgia rheumatica doctor before starting or changing your supplement use.

3. Ease symptoms and side effects

Polymyalgia rheumatica comes with symptoms that may not entirely disappear with treatment, particularly once steroid doses are lowered. The muscle pain, stiffness and morning difficulties can be a daily challenge. In addition, steroids can cause weight gain, thinned skin, headache, nausea and other side effects. If your symptoms or side effects are frequent or bothersome, talk to your doctor. You may have the wrong diagnosis, wrong medication dose or another problem that can be addressed.

• Consider natural painkillers. These may include eating spicy foods or bone broth, taking an Epsom salt bath, massaging sore muscles with peppermint oil or lavender oil (mixed in a carrier oil such as almond oil) and applying arnica oil to inflamed areas.
• Get a massage. Professional massages can significantly reduce both acute and chronic muscle and tissue pain. (7) Some people anecdotally also experience a lasting relief from polymyalgia rheumatica-related pain and stiffness for weeks following massages.
• Ease headaches naturally. Dr. Axe suggests magnesium, peppermint and lavender essential oil aromatherapy, feverfew and butterbur, B-complex vitamins and proper hydration for staving off or calming headaches.
• Get rid of nausea. Ginger or chamomile tea, chewable vitamin B6 tablets, peppermint oil or lemon oil aromatherapy and small meals may help ease nausea.
• Use assistive devices. If you have trouble moving in the morning, work out a series of shortcuts or invest in a few assistive devices to help you. These can include a rope or bed bar to help pull yourself out of bed, a shoe horn, a grabbing tool to help pick things up off the floor, a hand-held massager to help you rub out sore back or shoulder muscles and more.

4. Exercise or do physical therapy

Exercise not only helps relieve the pain and stiffness of polymyalgia rheumatica in the morning, it also helps fight potential health risks caused by steroids. These include weight gain, bone loss, poor blood sugar control and more. Here are some tips to help make sure your physical activity is helpful rather than harmful: (8)

• Start slow and easy. If you are not active, talk with a healthcare professional about the best options for you. In most cases, weight-bearing exercise, such as walking or climbing stairs, can be useful for preventing bone loss. Getting the body moving, even with low-impact activities, is better than rest for many people with polymyalgia rheumatica.
• Find a helpful morning routine. Stretching, yoga or another set of morning exercises may help you find some relief from morning pain and stiffness. Begin slowly and gently and gradually work to improve your range of motion or how long you hold poses. Take it easy, though. Too much exercise can make symptoms worse.
• Work with a physical therapist. A session or two with a physical therapy professional can give you a customized set of exercises to ease your pain, improve your range of motion, fight inflammation and relieve stiffness. The therapist should consider your current physical abilities, the key places and type of pain and stiffness you have in the morning, what limitations your symptoms cause and what you are hoping to achieve with your therapy. By practicing the exercises daily, you may start to notice improvement in your morning symptoms fairly quickly.

5. Ask about supplements and herbal remedies

The research is far from prescriptive about specific herbs and supplements to manage polymyalgia rheumatica. However, potentially helpful options for inflammation reduction, natural steroid production and relief of pain include: (9)

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• Traditional Chinese medicine — A study adding modified Yanghe Decoction to medical steroid treatment found that patients experienced a boost in remission rate and a decrease in disease activity and ESR. They could also lower their steroid dose faster than the control group (who took steroids alone). (10)
• Pantethine and vitamins A, B6 and C — These help your body make its own natural steroids and promote adrenal gland health. When the body’s steroid production works well, you may be able to naturally quell some inflammation. Ask about a dose of 600 milligrams per day for pantethine, 12,500–25,000 IUs per day for vitamin A, 50–100 milligrams per day for B6 (as part of a B-complex vitamin) and 1–2 grams per day of vitamin C.
• Omega-6 essential fatty acid (gamma linolenic acid or GLA) — Like omega-3 fatty acid, omega-6 is an anti-inflammatory natural oil that may reduce morning stiffness in people with polymyalgia rheumatica. It can be found in primrose oil capsules and borage oil capsules. Aim for 3,000 milligrams of omega-3 and 1,500 milligrams of omega-6 fatty acids daily.
• Enteric-coated bromelain — This enzyme is derived from pineapple and has been very helpful for many people with rheumatoid arthritis, which seems to have a very similar set of symptoms and inflammation as polymyalgia rheumatica. In clinical studies, bromelain supplements helped people reduce their steroid medications and reduced inflammation. Ask about 600 milligrams per day, taken on an empty stomach.
• Methyl-sulphonyl-methane (MSM) — This is a natural sulfur compound. Your body makes it to help fight pain and inflammation in the arteries. Ask about a short-term daily dose of about 1,000 milligrams to help ease joint pain and inflammation.
• Turmeric — Curcumin, or turmeric, may fight inflammation, pain and depression. Many studies have found it highly effective in managing symptoms of diseases related to polymyalgia rheumatica, such as rheumatoid arthritis. Ask a healthcare professional about the best daily dose for you.

Precautions

Polymyalgia rheumatica shares symptoms with several other health conditions. Do not attempt to self-diagnose the condition. Untreated polymyalgia rheumatica may simply cause long-term discomfort or limitations in movement. However, untreated conditions that can overlap or be mistaken for this disease, such as temporal arteritis or fibromyalgia, can cause serious health problems, including stroke. See a healthcare professional for diagnosis and to monitor your health.

The main medical treatment for polymyalgia rheumatica can cause many side effects, some of which can be severe or dangerous. Follow your physician’s advice for monitoring, follow-up and self-care. Report any changes in health, and take measures to manage side effects. Do not stop taking steroids without the guidance of a physician. Stopping them abruptly can cause serious health problems.

Natural remedies such as vitamins, herbs and supplements can impact your health, cause side effects and interact with medications. Always speak with a healthcare professional before starting, stopping or changing the remedies you use.

Key Points

• Polymyalgia rheumatica is an inflammatory disease that causes pain and stiffness in the shoulders. It can also affect the neck, back, buttocks, hips and thighs.
• There is no known cause of the condition, but risk factors include being female, being over the age of 50 and being of northern European or Scandinavian descent.
• Left untreated, polymyalgia rheumatica often goes away on its own in about a year. However, many people have trouble coping with the severity of the morning symptoms and seek treatment.
• Medical treatment typically includes a long-term low dose of steroids.
• You can try several natural approaches to polymyalgia rheumatica management, including an anti-inflammatory diet, calcium and vitamin D, easing symptoms and side effects, exercise or physical therapy and supplements and herbal remedies.