Polymyalgia rheumatica (PMR) is an inflammatory condition that results in severe pain and stiffness in the shoulders and hips. Read more about this condition that commonly affects older adults.
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, which lasts for 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. 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 with low doses of Corticosteroids. For chronic cases, along with Corticosteroid, Methotrexate or Tocilizumab is added. Prognosis is good, but it often recurs.
The symptoms affect both sides of the body. The signs and symptoms might include:
Shoulder pain and stiffness.
Pain in the neck, arms, buttocks, hips, and thighs.
Limited range of motion.
Pain and stiffness in wrists, elbows, or knees.
Limited range of motion.
Loss of appetite.
Unintended weight loss.
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.
The cause is still not clear, but there are many theories that try to explain the cause.
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.
Certain gene mutations might make you more susceptible to develop PMR.
A viral infection is believed to trigger PMR, but no particular virus has been identified.
PMR puts you at a higher risk of getting a condition called giant cell arteritis (GCA). GCA is the 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:
Pain in the muscles of the head.
Tenderness at the temples.
Aneurysm (enlarge) or stenosis (narrow) of blood vessels.
Jaw pain while chewing.
Scalp pain and swelling.
If you notice any of these symptoms, consult a doctor immediately. Your doctor will take a biopsy of the temporal artery, and start you on a high dose of steroids to prevent blindness.
The factors that increase the risk of polymyalgia rheumatica are:
Older adults between 70 and 80 years of age.
Women are twice as much susceptible to men.
More common in white people.
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.
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:
Bilateral shoulder pain.
Morning stiffness that lasts more than 45 minutes.
High levels of indicators of inflammation in the blood test, example ESR and CRP.
Absence of swelling in the small joints.
Absence of rheumatoid factors in blood tests.
Some of the tests that your doctor might tell you to take are:
Blood tests - To check complete blood count (CBC) and two indicators of inflammation, which are erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
Ultrasound - Ultrasound is used to distinguish PMR from other conditions like bursitis or tenosynovitis that result in similar symptoms.
MRI - To diagnose other conditions that can cause joint changes.
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.
Conditions that can result in the same signs and symptoms of PMR are:
Vasculitis (inflammation of blood vessels).
The treatment options include:
Corticosteroids - PMR is treated with a low dose of an oral corticosteroid like Prednisone. It usually relieves pain and stiffness in a couple of days. In 2 to 4 weeks, the dose is gradually decreased after assessing your blood test and symptoms. The dose is kept as low as possible without the symptoms relapsing. Corticosteroid has to be taken for almost a year, depending on how well you tolerate it.
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 1,200 to 1,500 mg, and that of vitamin D is 800 to 1,000 IU.
Methotrexate or Tocilizumab - Sometimes, Methotrexate or Tocilizumab is given along with the corticosteroid. Methotrexate is an immune-suppressing medication. It is usually given in cases of relapse or if you do not respond to corticosteroids.
Physiotherapy - If you not active because of the pain and stiffness, physical therapy will be helpful.
To ease symptoms, it is not advisable to take nonsteroidal anti-inflammatory drugs like Ibuprofen and Naproxen. Do not start any medication without consulting a doctor.
Some lifestyle changes that can help are:
Eat healthily. Consume fruits, vegetables, whole grains, lean meat, and low-fat dairy products. Reduce salt intake.
Exercise daily. You can do exercises like water aerobics, swimming, cycling, etc.
Sleep and rest properly, as this will help your body recover faster.
Proper posture while in office and at home.
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:
Osteoporosis (loss of bone density).
You will have to take medicines for a long time, but you will feel better in a few days of starting the medicine. For more information on treatment options, consult a doctor online.
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