Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) causes stiffness and muscle aches, particularly in the neck, shoulders and hips. Symptoms can appear almost overnight in some cases with no relief. As suddenly as it sometimes appears, it often goes away on its own in a year or two.

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Symptoms

PMR causes moderate to severe aching and stiffness in the muscles of the hips, thighs, shoulders, upper arms and neck. Most people have pain in at least two of these areas. At first, pain may be present on just one side of the body, but as the disease continues, symptoms are likely to occur on both sides.

Stiffness is usually worse in the morning. Trying to move without pain can leave those with PMR exhausted for the rest of the day, and pain may also be bad enough to awaken them at night.

Sometimes the aching and stiffness develop suddenly. In other cases, they appear more gradually.

Other signs include:

  • Fatigue
  • Weight loss
  • Slight fever

 

Causes and Risk Factors

The exact causes of PMR are not known. The inflammation that causes the pain occurs when white blood cells, which normally protect the body from invading viruses and bacteria, attack the lining of the joints, particularly the shoulders, hips and knees. PMR is usually less severe than rheumatoid arthritis.

Risk factors include:

  • Age - The average age of persons with this disease is 70.
  • Gender - Women are two times more likely to develop the condition than are men.
  • Ethnicity - Although people of any race can develop PMR, those most often affected are of Northern European or Scandinavian decent.
  • Other health conditions - Including giant cell arteritis. This condition causes the arteries in the temples to become swollen and inflamed. Half the people with giant cell arteritis also have PMR.
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Diagnosis

Because the symptoms of PMR are similar to those of rheumatoid arthritis and polymyositis, doctors need to rule out other possible causes of pain and stiffness. To aid in the diagnosis, the doctor will take a medical history, assess current symptoms and perform a physical exam. Tests may be ordered, such as:

A blood test to see how quickly red blood cells settle when placed in a test tube. Generally, the blood cells fall faster when inflammation is present, but because many conditions can cause inflammation in the body (including many forms of arthritis and other rheumatic diseases) this test alone cannot confirm the presence of PMR.

Rheumatoid factor (RF) test. RF is an antibody (a protein made by the immune system) that is often present in people with rheumatoid arthritis but not in the blood of people with PMR.

Other blood tests, including red blood cell and platelet counts. Platelets are colorless blood cells that help the blood clot. Most people with PMR have an unusually high number of these cells. On the other hand, many people with PMR have fewer red blood cells than normal and are often anemic.

After diagnosing PMR, doctors often check for giant cell arteritis, a related condition that occurs in some people with PMR. Between 15 to 25% of people with PMR also develop giant cell arteritis, and nearly half those with giant cell arteritis have PMR. The only way to confirm a diagnosis of giant cell arteritis is by taking a small sample (biopsy) from the artery in the temple (temporal artery) and examining it under a microscope. Because PMR and giant cell arteritis are treated in much the same way, the doctor may simply choose to begin treatment without the biopsy. Untreated, giant cell arteritis may lead to vision loss, a stroke or an aortic aneurysm (a potentially life-threatening bulge in the large artery that runs down the center of the chest and abdomen).

PMR itself causes few other problems, but the drugs used to treat the disease can cause complications.

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Treatments

Treatments for Polymyalgia Rheumatica include:

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (e.g., Advil and Motrin) for mild symptoms. These do not offer complete relief for many people, and long-term use can cause stomach and intestinal bleeding.

Corticosteroid drugs (such as prednisone) in low, daily doses. Relief should occur in a few days. If it does not, the condition is likely not PMR. After symptoms and blood test results have improved, the doctor will begin to lower the amount of the drug taken to reach the lowest possible level to control the condition. Most people are able to stop the drug within six months to two years. This type of drug has a number of side effects.

Ways to control the condition include:

Regular Exercise - Exercise can reduce the pain and improve overall sense of well-being. Emphasize low-impact exercises, such as swimming, walking and riding a stationary bicycle. Moderate stretching is also important for keeping the muscles and joints flexible. If you're not used to exercising, start out slowly and build up gradually, aiming for at least 30 minutes on most days. Your doctor can help you plan an exercise program that's right for you.

Eating a healthy diet - Eating well can help prevent potential problems, such as thinning bones, high blood pressure and diabetes. Good nutrition can also support the immune system. Emphasize fresh fruits and vegetables, whole grains and lean meats and fish, while limiting salt, sugar and alcohol. Get adequate amounts of bone-building nutrients (calcium and vitamin D). If you find it hard to get calcium from your diet because you can't eat dairy products, for example, try calcium supplements. These don't cost a lot, are well tolerated and absorb well if taken properly. Sometimes they can cause constipation. Good sources of calcium include skim, low-fat and whole milks; low-fat plain yogurt; Swiss, cheddar and ricotta cheeses; broccoli; canned salmon with the bones; tofu and orange juice and other products fortified with calcium.

Pace yourself - Try to alternate strenuous or repetitive tasks with easier ones to prevent straining painful muscles. Use luggage and grocery carts, reaching aids and shower grab bars to help make daily tasks easier.

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