What Is Polymyalgia Rheumatica?
Polymyalgia rheumatica (PMR) is a chronic inflammatory condition of unknown cause that affects older individuals, usually above 50 years. It is characterized by pain and morning stiffness in the hip, neck, and shoulder girdles, lasting more than half an hour.
It has been found that approximately 15 % of PMR patients develop giant cell arteritis (GCA), which is an inflammatory disease affecting large blood vessels of the scalp, arms, and neck. And more than 40 % of GCA patients have associated PMR. However, even though both of these conditions have the same onset and clinical presentation, the relationship between them is still not understood.
PMR is diagnosed based on the clinical presentation and after all other possible causes have been eliminated. This condition responds well to low doses of corticosteroids. For chronic cases, along with corticosteroids, Methotrexate or Tocilizumab are added. Prognosis is good, but it often recurs.
What Are the Symptoms of Polymyalgia Rheumatica?
The symptoms affect both sides of the body. The signs and symptoms might include:
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Shoulder pain and stiffness.
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Pain in the neck, arms, buttocks, hips, and thighs.
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Morning stiffness.
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Limited range of motion.
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Pain and stiffness in wrists, elbows, or knees.
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Fever.
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Tiredness.
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Anemia.
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Limited range of motion.
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Malaise.
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Loss of appetite.
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Unintended weight loss.
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Depression.
Consult your doctor if you experience new pain or stiffness, if the pain disrupts your sleep, and if you are unable to perform usual activities because of the pain and stiffness.
What Causes Polymyalgia Rheumatica?
The cause is still not clear, but there are many theories that try to explain the cause.
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Inflammation of the joints and the sacs surrounding the joints (bursae) is believed to cause pain, which radiates to other parts. For example, pain in the shoulder due to bursitis can radiate to the upper arm.
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Certain gene mutations might make you more susceptible to developing PMR.
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A viral infection is believed to trigger PMR, but no particular virus has been identified.
How Is Polymyalgia Rheumatica Associated With Giant Cell Arteritis?
PMR puts you at a higher risk of getting a condition called giant cell arteritis (GCA). GCA is a condition that results in inflammation of the arteries. It is an emergency condition, as there is a risk of permanent loss of eyesight or stroke. Some of the symptoms of GCA are:
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Severe headaches.
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Pain in the muscles of the head.
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Tenderness at the temples.
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Stroke.
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Night sweats.
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Depression.
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Fatigue.
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Aneurysm (enlarge) or stenosis (narrow) of blood vessels.
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Jaw pain while chewing.
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Scalp pain and swelling.
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Blurred vision.
If you notice any of these symptoms, consult a doctor immediately. Your doctor will take a temporal artery biopsy and start you on a high dose of steroids to prevent blindness.
What Are the Factors That Increase the Risk of Polymyalgia Rheumatica?
The factors that increase the risk of polymyalgia rheumatica are:
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Older adults between 70 and 80 years of age.
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Women are two times more susceptible than men.
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More common in white people.
What Are the Complications of Polymyalgia Rheumatica?
PMR can affect the ability to perform everyday activities, like getting out of bed, stepping out of a car, getting up from a chair, combing your hair, and dressing. These problems result in depression, sleep disturbances, and difficulties with social interactions. Some people tend to develop peripheral arterial disease.
How Is Polymyalgia Rheumatica Diagnosed?
Your doctor will perform a physical exam, which includes joint and neurological examinations. The results of these examinations can help diagnose the condition. The doctor might also check the range of motion of your joints by gently moving your head and limbs.
According to the new criteria by the American College of Rheumatology and The European League Against Rheumatism, patients older than 50 years can be diagnosed with PMR if they meet the following criteria:
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Bilateral shoulder pain.
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Morning stiffness that lasts more than 45 minutes.
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High levels of indicators of inflammation in the blood test, for example, ESR and CRP.
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Hip pain.
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Absence of swelling in the small joints.
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Absence of rheumatoid factors in blood tests.
In addition, some of the tests that your doctor might tell you to take are:
1. Blood Tests:
To check complete blood count (CBC) and two indicators of inflammation, which are erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
2. Ultrasound:
Ultrasound is used to distinguish PMR from other conditions like bursitis or tenosynovitis that result in similar symptoms.
3. MRI (Magnetic Resonance Imaging):
To diagnose other conditions that can cause joint changes.
4. Testing for Giant Cell Arteritis:
Everyone with PMR is also tested for GCA. Based on your symptoms, if your doctor suspects GCA, he or she will most likely take a biopsy of the artery present in your temple.
What Are the Differential Diagnosis of Polymyalgia Rheumatica?
Conditions that can result in the same signs and symptoms of PMR are:
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Rheumatoid arthritis.
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Vasculitis (inflammation of blood vessels).
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Infections.
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Muscular disorders.
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Cancer.
How Is Polymyalgia Rheumatica Treated?
The treatment options include:
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Corticosteroids:
PMR is treated with a low dose of oral corticosteroid like Prednisone. It usually relieves pain and stiffness in a couple of days. The dose is gradually decreased after assessing your blood test and symptoms. The dose is kept as low as possible without relapsing. Corticosteroid has to be taken for almost a year.
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Calcium and Vitamin D supplements:
To prevent bone loss caused by corticosteroids, you would have to take daily doses of calcium and vitamin D supplements. The daily dose of calcium is 1200 to 1500 mg, and that of vitamin D is 800 to 1000 IU.
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Methotrexate or Tocilizumab:
Sometimes, Methotrexate or Tocilizumab is given along with the corticosteroid. Methotrexate is an immune-suppressing medication. It is usually given in relapse cases or if you do not respond to corticosteroids.
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Physiotherapy:
If you are not active because of the pain and stiffness, physical therapy will be helpful.
What Are the Home Remedies for Polymyalgia Rheumatica?
Some lifestyle changes that can help are:
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Eat healthily.
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Consume fruits, vegetables, whole grains, lean meat, and low-fat dairy products.
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Reduce salt intake.
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Exercise daily. You can do exercises like water aerobics, swimming, cycling, etc.
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Sleep and rest properly, as this will help your body recover faster.
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Proper posture while in the office and at home.
What Are the Side Effects of Long-Term Use of Corticosteroids?
It is not advisable to start corticosteroid at a higher dose and then taper it off, as it results in relapse. Long-term use of corticosteroids can result in:
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Weight gain.
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Osteoporosis (loss of bone density).
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Hypertension.
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Diabetes.
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Cataracts.
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High cholesterol.
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Depression.
Conclusion:
If you are suffering from polymyalgia rheumatica, you will have to take medicines for a long time, but usually, you start feeling better within a few days after starting the medicine. It is not advisable to take nonsteroidal anti-inflammatory drugs like Ibuprofen and Naproxen. Do not start any medication without consulting a doctor.