Although some people develop these symptoms gradually, polymyalgia rheumatica can literally appear overnight. People with polymyalgia rheumatica may go to bed feeling fine, only to awaken with stiffness and pain the next morning.

Just what triggers polymyalgia rheumatica isn’t known, but the cause may be a problem with the immune system, perhaps involving both genetic and environmental factors. Aging also appears to play a role.

Polymyalgia rheumatica usually goes away on its own in a year or two. But you don’t have to endure polymyalgia rheumatica for months or years. Medications and self-care measures can improve your symptoms.

Polymyalgia rheumatica symptoms may include:

* Moderate to severe aching and stiffness in the muscles in your hips, thighs, shoulders, upper arms and neck
* Fatigue
* Unintentional weight loss
* Weakness or a general feeling of being unwell
* Sometimes, a slight fever
* Anemia — low red blood cell count

Initially, you may have pain on just one side of your body, but as the disease progresses, symptoms are likely to occur on both sides.

Stiffness is usually worse in the morning or after sitting or lying down for long periods. At times, the discomfort may also be severe enough to wake you at night.

The aching and stiffness of polymyalgia rheumatica often occur suddenly, but sometimes may develop gradually.

Between 10 percent and 20 percent of people with polymyalgia rheumatica have a related condition called giant cell arteritis, which causes the arteries in your temples and sometimes in your neck and arms to become swollen and inflamed.

Polymyalgia rheumatica is an arthritic syndrome that causes your muscles to feel achy and stiff due to mild inflammation in your joints and surrounding tissues. Most of the inflammation occurs in the hip and shoulder joints, but it may develop elsewhere in your body as well. In general, the inflammation isn’t as severe as that in inflammatory types of arthritis, such as rheumatoid arthritis.

In polymyalgia rheumatica, inflammation occurs when white blood cells — which normally protect your body from invading viruses and bacteria — attack the lining of your joints (synovium). Researchers aren’t sure what causes this abnormal immune system response, but they suspect that as with many disorders, both genetic and environmental factors are involved.

There may be a link between polymyalgia rheumatica and certain viruses, such as adenovirus, which causes respiratory infections ranging from the common cold to pneumonia; human parvovirus B19, the source of an infection that primarily affects children; and human parainfluenza virus.

Although the exact causes of polymyalgia rheumatica are unknown, certain factors may increase your risk of developing the disease, including:

* Age. Polymyalgia rheumatica affects older adults almost exclusively — the average age at onset of the disease is 70.
* Sex. Women are twice as likely to develop the condition as men are.
* Race. Although polymyalgia rheumatica can affect people of any race, the vast majority are white. People of Northern European and Scandinavian origin are particularly at risk.
* Giant cell arteritis. Also at risk are people with giant cell arteritis, a condition that causes arteries in your temples or sometimes other parts of your body to become swollen and inflamed. As many as half the people with giant cell arteritis also have polymyalgia rheumatica.

See your doctor if you suspect you have polymyalgia rheumatica. Some people delay getting medical care because they think it’s normal to have aching and stiffness as they grow older. But persistent pain is never normal. And because doctors can successfully treat polymyalgia rheumatica, you can be spared months or even years of unnecessary discomfort and disability.

If you’ve been diagnosed with polymyalgia rheumatica and experience new intense headaches, scalp tenderness, vision problems or achiness in your jaw, tell your doctor, as these may be symptoms of giant cell arteritis.

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1. Could my headaches, facial pain or other symptoms be due to temporal arteritis?
2. What else could be causing my symptoms?
3. What tests for temporal arteritis might I undergo, and what do they involve? Is a biopsy necessary?
4. How can temporal arteritis affect other conditions I may have?
5. How likely is it that I also have polymyalgia rheumatica?
6. Has my temporal arteritis impaired my vision? Is this change temporary or permanent?
7. How frequently should I see an ophthalmologist for eye exams?
8. How long will I likely need to remain on corticosteroids? What are their side effects? Can short-term intravenous corticosteroids reduce or eliminate my need for long-term oral corticosteroids?
9. Should I alter my diet?
10. Which exercises should I consider?
11. How long will it likely take to resolve my temporal arteritis? What are the chances I’ll experience a relapse?

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Recent small-scale research indicates that short-term intravenous corticosteroid therapy may treat temporal arteritis or decrease the need for long-term oral corticosteroids. If additional trials confirm these findings, patients may be able to avoid the risks of long-term corticosteroid use, which can include diabetes, osteoporosis and fractures.

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The most common of these complications is impaired vision or blindness. To reduce this risk, patients are typically referred to an ophthalmologist to watch for any signs of threatening blindness, such as involvement of arteries that supply the eyes with blood.

The most commonly prescribed medications for temporal arteritis are oral corticosteroids. These medications are started immediately in high doses to prevent blindness. In some cases, corticosteroid therapy may be initiated before diagnosis is confirmed with a temporal artery biopsy.

Although patients usually begin feeling better in just a few day, they typically continue taking a high dose for one month. As symptoms disappear and the risk of blindness is removed, the dose is gradually reduced to the lowest effective dose. Dosage must be reduced gradually because these drugs alter the body’s natural production of certain hormones. Stopping the medication suddenly can make a person very sick.

Most people can stop taking corticosteroids in six months to two years, but treatment is occasionally prolonged beyond this. Possible side effects of long-term use of corticosteroids include osteoporosis, fractures, diabetes, glaucoma, cataracts and high blood pressure. All side effects should be reported to a physician. A physician may recommend that patients on corticosteroids take supplements of calcium and vitamin D to reduce the risk of osteoporosis. Recent research suggests that high-dose intravenous corticosteroid therapy for only a few days may resolve temporal arteritis or reduce long-term need for oral corticosteroids.

Although the symptoms of temporal arteritis respond well to proper medication and treatment nearly eliminates the risk of serious complications, patients may wish to take certain other factors into consideration:

* Exercise. Important to maintain joint flexibility and muscle strength and function. Exercise may be particularly useful in dealing with possible drug-induced side effects, such as increased glucose (blood sugar) and decreased bone density. Low-impact exercises (e.g., swimming, walking) and stretching are usually emphasized. Patients should consult their physician before starting an exercise program. It is important to start slowly and work up gradually, particularly if the patient is not used to regular exercise.

* Nutrition. May help prevent such potential problems as thinning bones, high blood pressure and diabetes, which are associated with corticosteroid use. Proper nutrition can also strengthen the immune system. Fresh fruits and vegetables, whole grains and lean meats and fish are emphasized, as well as foods with plenty of calcium and vitamin D. Salt, sugar and alcohol are limited. Tobacco should be avoided.

When properly treated, temporal arteritis seldom recurs.

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* Pain and tenderness. A dull, persistent pain in the temples is the most common symptom of temporal arteritis. This pain is usually worsened by chewing. The face and scalp may also be painful and tender, and the pain may extend to the jaw and tongue. In addition to facial pain, a patient may experience ear pain or dental pain. Sore throats are common. In some cases, the muscles may ache.

* Headache. Dull headaches occur in about two-thirds of all temporal arteritis cases. These may occur on one or both sides of the head and may be moderate to severe. Headaches may be localized to the temporal regions or may be more generalized. They are typically chronic and may get worse over time.  Most patients suffering temporal arteritis report that the headache associated with it is markedly different from other headaches they have had.

* Jaw claudication (pain when chewing). The chewing (masticatory) muscles may become weak and painful. This occurs in about half of temporal arteritis cases.

* Abnormal temporal arteries. In about half of all cases of temporal arteritis, the temporal arteries develop a knobby thickening and become firm. They are generally tender to touch, and it may be difficult to feel a pulse within them.

* Vision problems. Blurred or double vision is a frequent complaint in people with temporal arteritis. Patients may experience eye pain, but the visual impairment can be painless. Sudden loss of vision, usually in only one eye but sometimes in both, is a less common but serious risk. The loss of vision may be transient. According to the Arthritis Foundation, this blindness occurs in 10 to 15 percent of cases.

* Fever. A fever may accompany temporal arteritis. Although typically low-grade, it may mimic the fever of an infection, such as pneumonia.

* Fatigue. Many temporal arteritis patients suffer from general fatigue.

* Weight loss. Temporal arteritis patients may experience a loss of weight.

* Upper respiratory complaints. A dry cough and moderate to severe sore throat occur in some cases.

* Horner’s syndrome. This involves a drooping upper eyelid, pupil contraction and receding eyeball. It may occur with temporal arteritis.

* Chest pain. Rarely, temporal arteritis is accompanied by chest pain, which suggests cardiovascular involvement.

Symptoms can also be due to other conditions, such as another form of vasculitis, Lyme disease, systemic lupus erythematosus, rheumatoid arthritis, amyloidosis (abnormal deposit of proteins in tissues) or TMJ disorder. A biopsy is used to identify temporal arteritis.

In many cases, temporal arteritis patients also suffer from pain and stiffness in the neck, arms and hips, particularly in the morning. This is a symptom of polymyalgia rheumatica, a condition that commonly occurs with temporal arteritis.

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* Age. This may be the most important risk factor for temporal arteritis. This condition almost exclusively affects people over the age of 50.  The likelihood of developing temporal arteritis increases as patients age and peaks in their 80s. Temporal arteritis can develop in children, according to the Arthritis Foundation, but this is exceedingly rare.

* Sex. Women are twice as likely as men to develop temporal arteritis.

* Genetics. There seems to be a genetic predisposition to temporal arteritis, which tends to run in families. In addition, it primarily affects people of Northern European descent.

* Climate. Temporal arteritis is more prevalent in colder latitudes. However, it is not known if this is because of the cold weather or the genetic makeup of the people living in those areas.

* Impairment of the immune system. An abnormal immune response appears to be a factor in temporal arteritis. Severe infections or heavy use of antibiotics may increase risk of the disorder.

* Viral factors. Some studies have suggested a link to pneumonia and parvovirus, but this remains highly controversial.

There seems to be a link between temporal arteritis and polymyalgia rheumatica. According to the National Institutes of Health, about 15 percent of Americans who have polymyalgia rheumatica also develop temporal arteritis. Further, about half of all temporal arteritis patients also have polymyalgia rheumatica. Patients may develop these conditions at the same time or may develop temporal arteritis after symptoms of polymyalgia rheumatica disappear.

People with rheumatoid arthritis may also be at an increased risk of temporal arteritis. Researchers have found that women who smoke or have cardiovascular problems such as murmurs might also be at greater risk of developing this disease.

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Arteries carry oxygen- and nutrient-rich blood to the body. The temporal arteries are the large arteries that branch off the carotid arteries in the neck and feed the head, eyes and optic nerves.

Although the arteries of the head are most commonly affected, those in the neck, arms and upper body (including the aorta and its branches) may also be affected. The temporal arteries on one or both sides of the head may be affected.

Inflammation and swelling causes the affected arteries to narrow, which reduces blood flow. There can also be death (necrosis) of arterial tissue. The artery may close entirely (occlude) because of severe inflammation or the formation of a blood clot that clogs the artery. In rare cases, an artery will weaken and bulge instead of swell, forming an aneurysm.

Without oxygen, cells begin to die. In severe cases, temporal arteritis can lead to permanent blindness in one or both eyes due to a lack of blood flow. Temporal arteritis is considered the prime ophthalmic emergency because prompt treatment can prevent blindness.

Other serious risks are much rarer. The swelling or blockage of certain arteries in the head may interrupt blood flow to the brain, resulting in a stroke. In late, untreated temporal arteritis, an aneurysm may form in the aortic artery. This aneurysm may burst and cause massive, life-threatening internal bleeding.

However, when temporal arteritis is treated it often resolves within a few months or years. It is not associated with increased mortality.

Temporal arteritis almost exclusively affects individuals over the age of 50. Women are affected twice as often as men, and the condition is most common in individuals of Northern European descent. Temporal arteritis is quite common. It is the most common type of vasculitis (inflammation of the blood vessels) in white Americans. According to the National Institutes of Health, about 200 per 100,000 Americans over age 50 develop temporal arteritis.

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Temporal arteritis, also known as giant cell arteritis, is characterized by dull, persistent pain in the head. This pain most often occurs in the temples, but may also affect the face, scalp, jaw and tongue. In many cases, the temporal arteries are tender and cord-like. Along with headaches and facial pain, patients may experience vision problems, from blurred or double vision to blindness. These signs and symptoms may be accompanied by low-grade fever and fatigue.

Temporal arteritis occurs in about 200 of every 100,000 people over age 50, according to the National Institutes of Health (NIH).  It is most likely to occur in people in their 80s.  It is twice as common in women as in men and rarely affects people younger than age 50.

Temporal arteritis seems to be linked to polymyalgia rheumatica, a type of rheumatic disorder marked by muscle pain and stiffness.  The NIH estimates that about half of all temporal arteritis patients also have polymyalgia rheumatica. About 15 percent of people with polymyalgia rheumatica also have temporal arteritis.

The cause of temporal arteritis is not known. Diagnosis relies on medical history, a physical examination, blood tests and an arterial biopsy to determine if cells lining the arteries are enlarged. Other tests, such as ultrasound, may also be used in diagnosis.

There is no known way to prevent temporal arteritis. The standard therapy is corticosteroids. If treatment is started early, symptoms are often quickly eliminated and serious complications (e.g., blindness, stroke) can be prevented. Typically the condition is resolved within a few months or years and is not chronic or fatal.

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1. What tests do I need for sarcoidosis? What do they involve?
2. What organs are affected by my sarcoidosis?
3. Is my sarcoidosis likely to spread to any other organs?
4. Does my sarcoidosis appear to be long term or short term?
5. Do I have tissue scarring?
6. How serious are my symptoms likely to be?
7. How often should I come in for follow-up appointments?
8. Should I receive treatment for my sarcoidosis?
9. If so, what are my treatment options? What are the risks and benefits of corticosteroids or other recommended treatments?
10. How long is the therapy likely to last?

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Sarcoidosis is typically treated only when symptoms are severe or if critical organs (e.g., heart, eyes, kidneys, central nervous system) are involved. Treatment is usually restricted to the most minimal forms that control symptoms and prevent serious complications. Even patients who require treatment can typically lead normal lives with no lasting disability. Treatment also depends on which organ system is involved.

In many cases, sarcoidosis improves or clears up spontaneously, with or without treatment. The granulomas (collections of inflammatory cells) go away, either disappearing or becoming scar tissue. In some cases, however, the scars may remain with or without treatment and symptoms may never go away. An affected organ may continue to function poorly. In rarer cases, symptoms continue to worsen and organ function continues to degrade.

The likelihood for full recovery is better when sarcoidosis has not spread beyond the chest, particularly if enlarged lymph nodes are present in the chest but there are no signs of lung disease. Chances are typically best when the disease begins with erythema nodosum (warm, tender, discolored bumps on the shins). Relapse occurs in about half of all sarcoidosis cases, both acute and chronic. Patients who experience spontaneous remissions (those without treatment) usually do not relapse. Patients whose remissions were induced by medications have a high rate of relapse. Spontaneous remission usually occurs within two to three years.

Very few instances of sarcoidosis lead to serious disability. When disability occurs, it is usually due to damage to the eyes (sometimes leading to blindness) or damage to the respiratory system. Damage elsewhere, such as in the heart or kidneys, can also cause serious problems. Fatalities are very rare, both in the acute and chronic forms of sarcoidosis. Lung scarring leading to respiratory failure is the most common cause of death, followed by bleeding caused by lung infections.

Sarcoidosis is typically actively monitored during and after treatment and when treatment is not required. Pulmonary function (breathing) tests are the most common method of monitoring the disease when it affects the lungs, but chest x-rays may also be used. Blood tests monitoring levels of calcium and enzyme tests measuring angiotensin-converting enzyme (ACE) are commonly used. Frequent eye tests are used to catch the possible development of sarcoidosis in the eyes and to monitor the disease when already present. These monitoring tests are also repeated regularly to detect relapses. Routine follow-up care typically lasts for two to three years.

Because most medications used for sarcoidosis suppress the immune system, patients may be more likely to get sick from an infection. Local therapy is typically the safest way to treat the disease because only the affected area is exposed to the drug. However, local therapy is possible only if the affected area can be easily reached. Drops and creams may be used for the eyes and skin. The eyes almost always respond well to treatment. Inhalers may be used to help with affected lung tissue but may not reach deep lung tissues.

Sarcoidosis typically does not increase chances of complications during pregnancy for the baby or the mother. The disease often improves during pregnancy and worsens after delivery.

When treatment is necessary, it is accomplished by means of medication. The medications that may be used include:

* Nonsteroidal anti-inflammatory drugs (NSAIDs), sometimes including COX-2 inhibitors. May be used in acute, minor cases.

* Corticosteroids. The main treatment for sarcoidosis. These may be given to suppress severe symptoms (e.g., shortness of breath, joint pain) that may occur when there are high levels of calcium, the heart, liver or nervous system is affected, or lung disease continues to worsen. Patients without symptoms typically do not take corticosteroids. These drugs control symptoms well but do not prevent lung scarring in chronic disease. They almost always relieve symptoms due to inflammation. However, there are some rare cases where patients do not respond to corticosteroids.

Corticosteroid treatment cannot be suddenly halted and usually lasts for several Osteoporosis involves the bones becoming thin, brittle and more prone to fracture, causing pain.months or even years in rare cases. Relapse is common but may depend on how quickly treatment was stopped. Longtime use of corticosteroids may have serious side effects, such as diabetes, glaucoma, cataracts or osteoporosis.

* Disease-modifying anti-rheumatic drugs (DMARDs). When corticosteroids are not effective, the patient may be switched to DMARDs, such as methotrexate. According to the National Institutes of Health, methotrexate works in 60 to 80 percent of patients with sarcoidosis. However, it is required for up to six months or more to relieve symptoms and may cause side effects, including an increased risk of infection, liver damage, and damage to fetuses. Another type of DMARD, hydroxychloroquine, is also effective in some patients with sarcoidosis. It is more likely to be effective if the disease has affected the skin or there is a high level of calcium in the blood. It may be helpful in eliminating skin lesions.

When sarcoidosis affects the heart, arrhythmia (irregularities in the heartbeat) may be present. Cardiac devices to regulate the heartbeat may be implanted under the skin. These include pacemakers and defibrillators.

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