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Rheumatoid Arthritis vs. Polymyalgia Rheumatica: Chart, Causes, Treatment

Polymyalgia rheumatica and rheumatoid arthritis are two diseases that manifest in a similar manner.

Polymyalgia rheumatica (PMR) and rheumatoid arthritis (RA) are two diseases that manifest in a similar manner.

It is no coincidence that the names RA and PMR sound similar.

  • Both are autoimmune illnesses in which the immune system attacks connective tissues in the body, resulting in joint pain and stiffness.
  • However, swelling is only found in RA, which is a significant difference.

These autoimmune disorders are difficult to identify. Their symptoms are similar to those of many other inflammatory and autoimmune diseases. They can cause a wide range of symptoms, and an individual may only have a few that are not considered characteristic of the disease.

Differences between RA and PMR

Table. Differences between RA and PMR

Features
RA
PMR

Differentiation
This is a type of inflammatory arthritis that causes inflammation in the synovial cavity (the thin membrane that lines the joints).
A systemic and autoimmune disease characterized by artery lining inflammation. It usually affects the arteries in the head, particularly those in the temples (giant cell arteritis).

Symptoms

  • Pain, swelling, and stiffness are symptoms of chronic inflammation.
  • Over time, RA can cause bone and joint deterioration, resulting in disability.
  • The wrists, fingers, knees, feet and ankles, and elbows are the most typically affected locations.
  • Other symptoms include:
    • Tiredness and a lack of energy
    • Fever
    • Sweating
    • Poor appetite
    • Weight loss
  • Sudden onset of severe pain and stiffness in the shoulders, neck, hip, and lumbar spine.
  • The pain usually worsens in the morning and can last for several hours.
  • Other symptoms include:
    • Fatigue
    • Fever
    • Weight loss
    • Depression
  • Nocturnal sweats

Age
RA most usually affects patients aged between 30 and 50 years.
PA typically affects patients older than 50 years, with an average onset age of 70 to 75 years.

Gender
Common in both males and females.
Most common in females.

SLIDESHOW

What Is Rheumatoid Arthritis (RA)? Symptoms, Treatment, Diagnosis
See Slideshow

8 common causes and risk factors of rheumatoid arthritis

Rheumatoid arthritis (RA) is an inflammatory disease that affects the body’s joints. It affects the joint lining, resulting in severe swelling. Although it is unknown what causes RA, many variables can raise the likelihood of acquiring the disease.

  • Genetic factors:
    • If a person’s close family members have RA, a person is more likely to suffer from RA.
    • Genetic variables alone may not be able to predict the disease. However, they increase a person’s risk of developing rheumatoid arthritis if other triggers are present.
  • Hormones: According to the Centers for Disease Control and Prevention (CDC), women are more likely than men to get RA. The findings imply that hormones are involved in the pathogenesis of RA.
    • Estrogen
    • Testosterone
    • Menopause
  • Age: Anyone can develop RA, but the risk increases with age. According to the CDC, it is expected to start when a person is in their 60s.
  • Smoking:
    • Smokers have a significantly increased risk of developing RA than nonsmokers. According to research, smoking can alter the body’s immunological response, especially in people who are genetically prone to develop RA.
    • Growing up in an environment where certain triggers, such as cigarette smoking, are present can raise a person’s risk of developing RA later in life.
  • Stress:
    • RA is an immune-mediated disease. The way the body reacts to stress may aggravate symptoms because chronic stress is a pro-inflammatory state.
    • Individuals suffering from rheumatic diseases frequently describe stressful events that occurred before the onset of symptoms.
  • Obesity:
    • According to the CDC, there is a link between obesity and the risk of developing RA.
    • Obesity may induce other medical concerns, such as metabolic disorders, which might exacerbate the adverse effects of RA according to research.
    • Cellular Inflammation due to obesity is a common component of both obesity and metabolic disorders.
  • Past Infection: The effect of a previous infection on the resistant framework may trigger RA. According to research, an infection may develop into RA if:
    • Some parts of the immune system lose their ability to deal with specific organisms (microorganisms or diseases).
    • The infection causes the immune system to overreact by producing new antigens.
  • Diet: Certain dietary items, according to researchers, may sometimes trigger the start of RA.
  • Some variables are unavoidable, but stopping smoking, maintaining healthy body weight, and eating a healthy diet low in processed foods may help some people with RA.

    6 common causes and risk factors of polymyalgia rheumatica

    Polymyalgia rheumatica (PMR) is a condition that causes significant pain and stiffness in huge muscle groups across the body. PMR’s etiology is unknown. However, scientific data suggest that it may occur as a result of the interaction of various elements.

  • Genetic predisposition: There is evidence to suggest that hereditary factors may increase vulnerability to PMR.
  • Viral Infections:
    • PMR has been linked to seasonal viral infections. The abrupt development of symptoms with occasional abatement seen in patients with PMR can be explained by viruses’ cyclic replication patterns.
    • Importantly, viruses, such as adenovirus, human parainfluenza virus, and parvovirus B19, have been linked to PMR.
  • Age:
    • Only adults aged older than 60 years are affected.
    • The cause is sometimes linked to the aging process.
  • Ethnicity:
    • More frequently seen in Caucasians though all ethnicities can be affected.
    • People of Northern European and Scandinavian descent have the highest risk of getting the disease.
  • Gender: Common in both males and females but more frequently seen in women.
  • Others:
    • Rarely, the disease occurs in an individual who has cancer.
    • Another hypothesized cause of PMR is overexposure to ultraviolet radiation from the sun, which damages the superficial arteries. 
    • According to certain research, ultraviolet rays harm the elastic fibers found in arteries and synovial membranes. These injured tissues may become infected by viruses that lay dormant for a long period and then reactivate, resulting in PMR.
  • New cases of polymyalgia rheumatica appear in cycles, presumably periodically. This implies that an environmental trigger, such as a virus, could be involved.

    Researchers are trying to figure out what causes PMR. The illness can develop swiftly and is more common at particular seasons of the year.

    QUESTION

    The term arthritis refers to stiffness in the joints.
    See Answer

    What are the treatment options for PMR and RA?

    Polymyalgia rheumatica

    It is usually suggested to treat polymyalgia rheumatica (PMR) in its early phases. Most patients with PMR are treated with anti-inflammatory medicines. 

    • Nonsteroidal anti-inflammatory drugs (NSAIDs)
      • NSAIDs aid in the relief of pain and inflammation produced by polymyalgia rheumatica.
      • They are not as effective as prednisone for the initial treatment of PMR. However, when combined with prednisone, they can be useful.
    • Disease-modifying anti-rheumatic drugs (DMARDs)
      • DMARDs are drugs that are commonly used to treat inflammatory arthritis, such as rheumatoid arthritis (RA). To treat polymyalgia rheumatica, a rheumatologist may prescribe these drugs.
    • Analgesics (painkillers)
      • Analgesics can help with pain, but they don’t prevent additional joint damage.
      • Analgesics include over-the-counter medications, such as acetaminophen, as well as harsher prescription opioids, such as morphine.
    • Corticosteroids (prednisone)
      • Prednisone is the most used medicine in the treatment of polymyalgia rheumatica.
      • Prednisone usually makes most people feel better within 24 hours, and the dose is gradually reduced over time.
      • To control inflammation, most patients continue to take a modest dose of prednisone for at least a year.
    • Others
      • Doctors may recommend calcium and vitamin D supplement daily to safeguard the bones.
      • A combination of treatments may be recommended by doctors.
      • Patients with polymyalgia rheumatica may benefit from physical therapy and exercise in addition to medicines.
      • Exercise and stretching help alleviate shoulder and hip pain and stiffness, as well as protect the joints from additional harm.
      • Daily exercise can help manage fatigue and mental health issues linked with PR.

    Rheumatoid arthritis

    RA has no known cure. The goal of treatment is frequently to reduce pain and flares and keep inflammation to its minimum while preserving function. Patients could be receiving one or more types of treatment.

    • A low-dose steroid and disease-modifying antirheumatic medication (DMARD) offer the best management.
    • Steroid injections and biologic DMARDs suppress a component of the immune system that causes RA.
    • These injectable medications may slow the progression of RA, but they may have substantial side effects.
    • Combine these drugs with lifestyle changes to limit the progression of the condition. Physical activity is an essential part of the healing process.
    • Patients have benefited from cognitive behavioral therapy, which can help patients identify pain triggers and provide coping methods to improve the overall quality of life.
    • Pain relievers, muscle relaxants, and low-dose antidepressants are sometimes taken together.
    • Along with joint replacement choices, patients may be prescribed joint replacement solutions to restore mobility and lessen the need for various pain medications. The orthopedic surgeon may explore the potential of joint replacement.
    • Arthrodesis (also called joint fusion) and tendon repair are common options.

    Physical or occupational therapy may be used as part of a patient’s RA and PMR treatment. These activities can help maintain joint flexibility and muscle strength.

    With the correct therapy, the diseases can usually be completely and swiftly treated, allowing those affected to continue their everyday activities.

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    Medically Reviewed on 3/4/2022

    References

    Image Source: iStock Images

    Cutolo M, Cimmino MA, Sulli A. Polymyalgia rheumatica vs late-onset rheumatoid arthritis. Rheumatology (Oxford). 2009 Feb;48(2):93-5. https://academic.oup.com/rheumatology/article/48/2/93/1788833

    Caporali R, Montecucco C, Epis O, Bobbio-Pallavicini F, Maio T, Cimmino MA. Presenting features of polymyalgia rheumatica (PMR) and rheumatoid arthritis with PMR-like onset: a prospective study. Ann Rheum Dis. 2001 Nov;60(11):1021-4. https://ard.bmj.com/content/60/11/1021

    Wasserman AM. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2011 Dec 1;84(11):1245-52. https://www.aafp.org/afp/2011/1201/p1245.html

    Versus Arthritis. Polymyalgia rheumatica (PMR). https://www.versusarthritis.org/about-arthritis/conditions/polymyalgia-rheumatica-pmr/

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