In life, we often encounter such middle-aged and elderly people who always feel pain all over their bodies, either here or there, but when they go to the hospital for examination, they cannot find out what the disease is. With the readers’ questions, our reporter went to the First Hospital of Sun Yat-sen University and interviewed Professor Yang Cuiyan, a famous rheumatologist in China. Professor Yang said that this is true, especially in the rheumatology clinic, this situation is very common in elderly patients. They wake up in the morning with aches and pains all over their body, and the muscles and joints are stiff and painful, but it is often difficult to point out a specific joint pain, and it is not clear when the pain starts. The patient was suspected of having rheumatoid arthritis or osteoporosis. After detailed history and examination, rheumatoid arthritis, antinuclear antibody-related connective tissue disease, tumor and chronic infection (especially tuberculosis) were ruled out, followed by osteoporosis and osteoarthritis, and the only laboratory tests were increased blood sedimentation and C-reactive protein, and finally rheumatic polymyalgia was diagnosed. What exactly is rheumatic polymyalgia? According to Prof. Yang, rheumatic polymyalgia is very common in foreign countries, but in China, it is not only not well known to the general public, but also not well known to clinicians. Rheumatic polymyalgia is a common disease in western countries, and the number of people suffering from it in the elderly population in China is not small. It is only in the last decade or so that Chinese rheumatologists have started to pay attention to rheumatic polymyalgia, while doctors in other specialties are even more unfamiliar with this disease. Due to the non-specific clinical symptoms and the lack of diagnostic laboratory indicators, rheumatic polymyalgia is often interpreted clinically as osteoporosis or “rheumatic pain in the elderly”. Many patients are even delayed in diagnosis for many years, suffering from pain until they gradually lose their physical ability, cannot walk and take care of themselves, and finally end up bedridden and finish their lives, interpreted as “dying of old age. “If detected early, once diagnosed, most of them do not require hospitalization, but only outpatient medication, and the improvement of symptoms is very obvious. In addition to relieving pain, treatment is more important to prevent the disease from causing “gradual physical decline and death”, thus extending the life span of the elderly.” Professor Yang said, “Nowadays, with good living conditions, old people want to live a long, healthy and comfortable life.” Rheumatic polymyalgia mainly occurs in the elderly over 60 years old, a few more than 50 years old, the older the age the higher the prevalence, the average age of 70 years old, both men and women can develop. Currently, the etiology and pathogenesis of rheumatic polymyalgia are still unclear. Its etiology may be multifactorial, with a combination of intrinsic factors and environment leading to immune inflammation through immune mechanisms. Therefore, its most important features are increased blood sedimentation and C-reactive protein, which reflect the body’s inflammatory response. Prof. Yang said that patients often have more complaints and generalized pain and discomfort, mostly starting with symptoms in the neck and back of the shoulders, then progressing to the proximal extremities, neck, chest and buttocks, and sometimes distal muscle groups and joints can also be involved, directly affecting the patient’s life. The stiffness and pain are obvious in the morning or when starting activities after a sedentary rest. Morning stiffness can be seen in the evening when going to bed, but in the morning when waking up, the whole body is painful and stiff, and the duration of morning stiffness can be as light as half an hour or as heavy as several hours, or even the whole day. The muscle weakness starts with the pelvic girdle and thighs, and gradually progresses to whole body muscle weakness. In severe cases, daily activities are limited, and there are difficulties in combing hair, shaving, dressing, squatting, going up and down stairs, even turning over in bed and sitting up, and muscle atrophy may occur to further aggravate muscle weakness. Some patients may show fluctuating remission alternating with relapses. Patients with rheumatic polymyalgia have many complaints and symptoms, but few positive signs are associated with them on physical examination, presenting a typical mismatch between symptoms and signs. Laboratory tests also show only non-specific increased inflammatory indicators (blood sedimentation, C-reactive protein, etc.). Therefore, “the diagnosis is entirely dependent on the characteristics of the clinical presentation and the clinician’s cognitive degree.” Professor Yang said, “This makes the diagnosis of rheumatic polymyalgia more difficult.” Diagnostic points and treatment concepts of rheumatic polymyalgia While focusing on the diagnosis and treatment of rheumatic polymyalgia, we need to pay high attention to giant cell arteritis. Because giant cell arteritis often accompanies rheumatic polymyalgia, it is even widely accepted in the medical community that this is likely to be a different manifestation of the disease process. The symptoms of rheumatic polymyalgia are often clinically interpreted as osteoporosis or “rheumatic pain of the elderly,” and the symptoms of giant cell arteritis are often attributed to “atherosclerosis,” resulting in a delayed diagnosis of giant cell arteritis and rheumatic polymyalgia. Giant cell arteritis most often involves the temporal artery and is also known as temporal arteritis. Signs of temporal artery exposure are more common in male patients. The temporal artery is the subscalp area that runs from the parauricular area through the temples up to the top of the head and temporal area. The temporal artery often shows tenderness and bead-like anger, and pulsation may be palpable or may disappear. The inflammatory narrowing of blood vessels can affect the blood supply to the five senses of the head and face, and the corresponding symptoms appear. Therefore, Prof. Yang reminded the readers that tinnitus or hearing loss, loss of vision, diplopia, new onset of headache, jaw claudication, unexplained fever, unexplained general discomfort symptoms, anemia, and increased blood sedimentation over the age of 50 need to be alert to giant cell arteritis and rheumatic polymyalgia. Professor Yang introduced the treatment and medication philosophy of giant cell arteritis and rheumatic polymyalgia to the reporter: treatment is mainly to relieve symptoms, stop the progression of lesions and prevent damage to important organ functions. With proper treatment, rheumatic polymyalgia can be rapidly controlled, relieved or cured; it can also be prolonged or recurrent; and serious conditions such as muscle wasting atrophy or shoulder capsular contracture can occur in the later stages of the disease. The prognosis for rheumatic polymyalgia without giant cell arteritis is good. Impairment of vision and hearing is more common in giant cell arteritis and is usually irreversible, usually requiring treatment for more than 2 years or longer. Elderly patients with giant cell arteritis combined with rheumatic polymyalgia have a high mortality rate if diagnosis and proper treatment are not obtained. Recent improvements in early diagnosis and treatment have resulted in a significant decrease in the death rate. Giant cell arteritis has a poor prognosis if it involves the central vessels (branches of the internal carotid artery) and leads to cerebral infarction. Long-term chronic aortitis that leads to aortic aneurysm or entrapment also poses a risk of rupture. Therefore, rheumatic polymyalgia can be treated relatively conservatively, while giant cell arteritis requires more aggressive treatment. Finally, Professor Yang summarized for the reporter a disease that can easily be delayed in diagnosis in one sentence: An elderly patient with generalized aches and pains who has normal tests of all kinds, except for elevated sedimentation and C-reactive protein, should be on high alert for rheumatic polymyalgia and recommended to see a rheumatologist.