Polymyalgia rheumatica (muskelgigt) – assessment at Charlottenlund Privathospital
Rheumatology specialists assess polymyalgia rheumatica on an outpatient basis.
Muskelgigt (polymyalgia rheumatica, PMR) er en betændelsessygdom, der giver smerter og udtalt stivhed i skuldre, nakke, hofter og lår – værst om morgenen – hos personer over 50 år. Sygdommen skyldes betændelse i led, slimsække og seneskeder omkring skulder- og hoftebæltet, ikke i musklerne selv, og den viser sig ved forhøjede betændelsestal i blodet. Diagnosen stilles på symptombillede, blodprøver og ultralyd, efter at andre sygdomme er udelukket. På Charlottenlund Privathospital udredes muskelgigt af speciallæger i reumatologi på Jægersborg Allé 4 i Charlottenlund, og behandlingen foregår efter gældende retningslinjer i sygehusregi.
What is polymyalgia rheumatica?
Despite its name, polymyalgia rheumatica is not a muscle disease. According to the Danish Society of Rheumatology's national treatment guidelines, it is an inflammation of the structures around the shoulder and hip joints – joint capsules, bursae and tendon sheaths – causing the characteristic pain and stiffness in the shoulder girdle and hip region. The disease almost exclusively affects people over 50, most commonly after the age of 65–70, and is more common in women than in men.
Polymyalgia rheumatica is related to giant cell arteritis (temporal arteritis), an inflammation of the large arteries that can occur at the same time in a small proportion of patients. For this reason, assessment always includes questions about headache, tenderness at the temples, pain when chewing and visual disturbances. With appropriate treatment, polymyalgia rheumatica has a good prognosis, and most people can stop treatment after one to two years.
What are the symptoms of polymyalgia rheumatica?
Typiske tegn på muskelgigt:
- ✓ Smerter og stivhed i begge skuldre og overarme
- ✓ Ofte også nakke, hofter, balder og lår
- ✓ Morgenstivhed, der varer mere end 45 minutter
- ✓ Svært ved at løfte armene, tage tøj på eller rejse sig
- ✓ Begyndt i løbet af dage til få uger
- ✓ Træthed, let feber, nedsat appetit eller vægttab
The disease typically develops over a few days to a few weeks. The main symptoms are pain and stiffness in both shoulders and upper arms, often also in the neck, hips, buttocks and thighs. Stiffness is worst in the morning and after resting and can last more than 45 minutes. Many people have difficulty raising their arms, getting dressed, turning over in bed or standing up from a chair. A general feeling of being unwell, fatigue, a mild fever, reduced appetite and weight loss may also occur.
Symptoms that may indicate coexisting giant cell arteritis include a new headache, tenderness of the scalp or temples, jaw pain when chewing, and temporary or permanent loss of vision. These symptoms must be assessed by a doctor the same day, because treatment for giant cell arteritis must begin as soon as possible.
What causes polymyalgia rheumatica?
The cause is unknown. Age is the strongest risk factor, and hereditary factors play a role. The disease is caused by an inflammatory reaction in the tissue around the large joints, and the inflammation can be measured in the blood as elevated CRP and ESR. Polymyalgia rheumatica is not caused by overuse or wear and tear, and is not related to osteoarthritis, even though both are common in the same age group.
How is polymyalgia rheumatica diagnosed?
Polymyalgia rheumatica is a diagnosis of exclusion: there is no single test, and several other conditions can cause similar symptoms. Assessment is based on the medical history – age, symmetrical symptoms in the shoulder and hip girdles, morning stiffness and sudden onset – combined with a clinical examination, blood tests and ultrasound scans. According to the international EULAR/ACR classification criteria (2012), factors include age over 50, pain in both shoulders, morning stiffness lasting more than 45 minutes, elevated inflammatory markers, negative rheumatoid factor and ultrasound findings of inflammation in the shoulder and hip regions.
Blood tests include inflammatory markers, rheumatology tests, thyroid function, muscle enzymes, kidney and liver function, and a blood count. Ultrasound scans of the shoulders and hips can show inflammation in the bursae and tendon sheaths, supporting the diagnosis while also helping to rule out late-onset rheumatoid arthritis, muscle inflammation, thyroid disease, infection and other causes. If there are symptoms of giant cell arteritis, an ultrasound scan of the temporal arteries and, if necessary, a biopsy are also performed.
How is polymyalgia rheumatica treated?
Symptomernes debut, døgnvariation og udbredelse. Undersøgelse af skuldre, hofter, led og bevægelighed – og spørgsmål om hovedpine, tyggesmerter og syn.
Betændelsestal, gigtprøver, stofskifte, muskelenzymer, nyre- og levertal og blodprocent – tages samme dag.
Skuldre og hofter scannes for betændelse i slimsække og seneskeder; andre årsager udelukkes.
Ved bekræftet mistanke henvises med den færdige udredning, så behandlingen kan begynde i sygehusregi uden forsinkelse.
Treatment consists of corticosteroid tablets taken over an extended period, with gradual tapering and regular monitoring of symptoms, inflammatory markers and side effects. According to the latest recommendations from European rheumatologists, treatment should be provided in a specialist setting. At Charlottenlund Privathospital, assessment takes place here, while treatment is started and monitored by the hospital. If the diagnosis is confirmed, you will be referred with the completed assessment so treatment can begin without delay.
When should I see a rheumatologist?
A rheumatology assessment is recommended for people over 50 who develop pain and stiffness in both shoulders or hips, particularly when morning stiffness is pronounced, inflammatory markers are elevated, or there is a general feeling of being unwell. It is also relevant when the diagnosis is uncertain, corticosteroid treatment does not work as expected, tapering leads to repeated relapses, or side effects mean that treatment needs to be adjusted. Headache, tender temples, jaw pain when chewing or visual disturbances require assessment the same day.
Assessment and treatment at Charlottenlund Privathospital
Assessment and treatment are provided by rheumatology specialists on an outpatient basis. The initial consultation typically lasts half an hour; blood tests and ultrasound scans of the shoulders and hips can often be done the same day. If the diagnosis is confirmed, a treatment and tapering plan is drawn up.
Most patients come through health insurance; insurers typically require a referral from your GP and prior authorisation before an appointment can be booked. No referral is needed if you are paying for your treatment yourself, and prices are listed in the price list. Appointments can be booked online around the clock or by phone on 44 98 19 21 Monday to Friday, 08:00–14:00. Outside phone hours, the digital phone assistant Anna can book, cancel and reschedule appointments.
Frequently asked questions
Are muskelgigt and polymyalgia rheumatica the same condition?
Yes. Muskelgigt is the Danish name for polymyalgia rheumatica, often abbreviated to PMR.
What is the difference between polymyalgia rheumatica and fibromyalgia?
Polymyalgia rheumatica is an inflammatory disease that causes elevated inflammatory markers, affects people over 50 and responds to corticosteroids. Fibromyalgia is a chronic pain condition without inflammation, often develops at a younger age and does not respond to corticosteroids.
Can polymyalgia rheumatica be detected with a blood test?
Inflammatory markers CRP and ESR are typically elevated, but they are not specific to polymyalgia rheumatica. Blood tests are used alongside symptoms and ultrasound, and to rule out other conditions.
How long does treatment for polymyalgia rheumatica last?
Treatment is long term, with gradual tapering, and is managed by the hospital. Some people need treatment for longer, and relapses during tapering are common.
What happens if polymyalgia rheumatica is left untreated?
Symptoms persist and affect daily functioning and sleep, and there is a greater risk of missing coexisting giant cell arteritis. With treatment, symptoms usually improve quickly, which is why referral should not be delayed.
What is giant cell arteritis?
Inflammation of the large arteries, especially the temporal arteries, which can occur alongside polymyalgia rheumatica. Headache, tender temples, jaw pain when chewing and visual disturbances are warning signs that require medical assessment the same day.
Is polymyalgia rheumatica treated at Charlottenlund Privathospital?
Your assessment takes place here; treatment with corticosteroids is started and monitored by the hospital following referral with the completed assessment.
Is polymyalgia rheumatica hereditary?
Hereditary factors increase the risk somewhat, but the disease is not directly inherited. Age is the most important risk factor.
Can you exercise with polymyalgia rheumatica?
Yes. When treatment is working, regular physical activity is recommended. It can also help counter corticosteroid side effects such as muscle loss and osteoporosis.
Do I need a referral to be assessed for polymyalgia rheumatica at Charlottenlund Privathospital?
If you are using health insurance, your insurer will typically require a referral from your GP and prior authorisation. No referral is needed if you are paying for your treatment yourself.