Polymyalgia rheumatica (PMR) is an inflammatory condition that causes pain and stiffness, typically affecting the large muscle groups around the shoulders and hips. The symptoms, which often appear rapidly, can be mistaken for normal signs of aging, leading some to delay seeking medical care. Ignoring PMR, however, allows this underlying inflammation to persist and progress, resulting in a cascade of increasingly severe health consequences. Understanding these specific risks highlights why timely diagnosis and intervention are important for managing this condition.
Persistent Pain and Functional Decline
The immediate consequence of untreated PMR is the ongoing impairment of daily physical function. Uncontrolled inflammation in the shoulder and hip girdles results in significant muscle pain and stiffness, which is characteristically worse in the morning or after periods of rest. This stiffness often persists for more than 30 minutes after waking, severely limiting mobility.
Without treatment, performing simple, routine tasks becomes a struggle, leading to a functional decline that impacts independence. Activities like dressing, combing hair, or rising from a low chair can become nearly impossible due to the pain and restricted range of motion. This chronic limitation compels individuals to limit their movement drastically to avoid pain.
The resulting disuse contributes to muscle atrophy and weakness in the affected areas, compounding the disability. This cycle of pain, disuse, and decline can quickly lead to an increased reliance on others for basic personal care and mobility assistance.
The Critical Link to Giant Cell Arteritis
A far more serious consequence of untreated PMR is the development of Giant Cell Arteritis (GCA), also known as temporal arteritis. PMR and GCA are closely related inflammatory disorders, and approximately 10% to 20% of PMR patients may develop this severe complication. GCA is a form of vasculitis, involving inflammation of the blood vessel walls, particularly those supplying the head and eyes.
The inflammation in GCA narrows or blocks these arteries, interrupting blood flow. Symptoms that prompt immediate medical attention include a new, persistent, or severe headache, frequently felt around the temples. Other signs are jaw claudication and tenderness or pain on the scalp.
The most devastating outcome of GCA is sudden, permanent vision loss, which can occur in one or both eyes when inflammation blocks blood flow to the optic nerve. If GCA is not rapidly diagnosed and treated with high doses of corticosteroids, the visual impairment can become irreversible within hours or days.
GCA is not limited to the head and neck; it can also affect the aorta and its branches. Inflammation in these large vessels can lead to an increased risk of serious cardiovascular events, including aortic aneurysms or dissections.
Other Long-Term Systemic Complications
Persistent, uncontrolled inflammation from PMR contributes to a range of chronic systemic health problems. PMR is characterized by elevated inflammatory markers, which signal ongoing immune system activity. This sustained inflammatory state contributes to various issues throughout the body.
Chronic inflammation is known to damage blood vessel linings, increasing the risk of cardiovascular disease over time. Untreated PMR is associated with a higher likelihood of conditions like atherosclerosis, which can lead to heart attack and stroke.
Patients with untreated PMR often experience constitutional symptoms, including profound fatigue, malaise, and unintended weight loss. This continuous state of feeling unwell can also lead to the development of mild anemia of chronic disease, as the inflammatory response interferes with red blood cell production.
The unrelenting pain and physical limitations of untreated PMR also impact mental well-being. Chronic pain, disability, and the subsequent loss of independence frequently contribute to the development of anxiety and depression. This psychological burden diminishes the patient’s quality of life.
The Goals of Necessary Medical Treatment
The standard medical approach for PMR, typically involving low-dose oral corticosteroids like prednisone, is highly effective and aims to rapidly reverse the negative consequences of the untreated disease. Treatment focuses on quickly suppressing the systemic inflammation responsible for the symptoms and complications. Patients frequently experience dramatic relief from pain and stiffness within one to three days of starting therapy.
The immediate goal is to control painful myalgia and improve muscle stiffness, restoring the patient’s ability to perform daily activities and preventing functional decline. A long-term objective of initiating treatment is the prevention of GCA. While low-dose steroids may not fully prevent GCA, prompt diagnosis and monitoring allow for immediate, high-dose intervention if GCA symptoms appear.
By reducing the overall inflammatory load, medical treatment also mitigates long-term systemic risks, such as increased susceptibility to cardiovascular issues. Treatment often lasts for one to two years or more, allowing for sustained disease control and a significant improvement in the patient’s prognosis and quality of life.