12 Types of Arthritis and How They Differ

11. Polymyalgia Rheumatica - The Great Stiffness

Polymyalgia rheumatica represents an inflammatory condition that primarily affects adults over 50 years of age, characterized by severe muscle pain and stiffness in the neck, shoulders, and hips, often accompanied by constitutional symptoms such as fatigue, low-grade fever, and weight loss. This condition has a strong predilection for individuals of Northern European descent and shows a clear female predominance, with women being affected twice as often as men. The hallmark symptom is profound morning stiffness lasting more than one hour, particularly affecting the shoulder and hip girdles, making simple activities like getting out of bed, combing hair, or putting on clothes extremely difficult. Unlike true arthritis, polymyalgia rheumatica primarily affects muscles and surrounding soft tissues rather than joints themselves, though some patients may experience mild joint swelling. The condition is closely associated with giant cell arteritis (temporal arteritis), with approximately 15-20% of polymyalgia rheumatica patients developing this serious vasculitic complication that can lead to blindness if untreated. Laboratory findings typically show markedly elevated inflammatory markers, with erythrocyte sedimentation rates often exceeding 50 mm/hour and elevated C-reactive protein levels. The diagnosis is largely clinical, supported by laboratory findings and dramatic response to low-dose corticosteroids, which often provide relief within days of initiation. Treatment typically involves prednisone starting at 15-20 mg daily, with gradual tapering over 1-2 years, though some patients require longer treatment periods or steroid-sparing agents such as methotrexate.