Polymyalgia Rheumatica Overview
Polymyalgia rheumatica (PMR) is a common cause of morning aching and stiffness in older adults. It can be difficult to diagnose because it does not usually cause swollen joints or other abnormalities that can be detected by a physical exam. The cause of PMR is not known. It typically affects the shoulder and hip joints. Treatment may include a trial of low-dose steroids; if PMR is present, stiffness is quickly relieved. Symptoms can come on quite suddenly; the disease usually disappears within 2-6 years.
Pain and stiffness in the shoulders, neck and hips are common symptoms. The pain is usually worse at night and persists more than 30 minutes in the morning. Others are anemia, depression and flu-like symptoms including appetite loss and resulting weight loss, fever and weakness. Patients with PMR can find it hard to get out of a chair or a car and may have trouble with bathing, dressing and other personal tasks.
Some patients with PMR also have giant cell arteritis, a more serious condition that can result in heart attack, stroke or sudden blindness. Its symptoms include headache, pain and tenderness of the temples, visual problems, dizziness and balance issues.
Risk factors include:
- Being an older adult; few people younger than 50 get PMR.
- Being female; women are twice as likely as men to get it.
- Being of northern European and Scandinavian descent.
- A family history of the disease.
- A diagnosis of giant cell arteritis, which causes inflammation of the lining of the arteries in the head. More than 60% of people with giant cell arteritis may have PMR.
Polymyalgia Rheumatica Prevention
There is no known way to prevent the disease.
Polymyalgia Rheumatica Diagnosis
Your doctor will ask you in-depth questions about onset of symptoms, pain level, the nature of your stiffness and whether you have headache, vision changes or jaw pain. Although lab tests alone cannot definitively diagnose PMR, most people with the disease have an elevated sedimentation rate (ESR). This is determined by a blood test for certain types of inflammation.
Test results can identify disease indicators including:
- Abnormal proteins in the blood
- Abnormal white blood cells
- Reduced hemoglobin (an oxygen-carrying protein in red blood cells) and hematocrit (packed cell volume) levels
Polymyalgia Rheumatica Treatment
If your Wellstar rheumatologist believes you may have polymyalgia rheumatica, he or she may recommend a trial of low-dose corticosteroids, such as prednisone. If PMR is present, the stiffness will be quickly relieved. If 2-3 weeks of treatment do not have a positive effect, the diagnosis may be revised.
Once symptoms are under control, the dose of steroids is gradually decreased with the goal of finding the minimum effective dose to relieve the stiffness. This can be a difficult balance to achieve. Some patients can stop the medication within a year, but others will need a small dose for several years.
Many doctors prescribe daily doses of calcium and vitamin D, which can help prevent bone less related to steroid use. Physical therapy helps some patients regain strength and coordination.
Ongoing Care for Polymyalgia Rheumatica
Many people live relatively pain-free lives despite a diagnosis of polymyalgia rheumatica. Once the pain has subsided, you can enjoy regular activities, including appropriate exercise. Your physician will talk with you about the effects of taking steroids. These can include elevated blood sugar level, weight gain, sleeplessness, osteoporosis (bone loss), cataracts, bruising and thinning of the skin. During regular visits your doctor will look for these and other side effects.
Patients with PMR are advised to contact their rheumatologist if they experience headache, fever or vision changes. These can be an indicator of giant cell arteritis.
Following healthy lifestyle guidelines can help reduce the side effects of steroids. These include:
- Eating a diet rich in fruits vegetables, whole gains and low fat meat and dairy products and restricting foods with high levels of refined sugars and sodium (salt).
- Getting regular, appropriate exercise to help strengthen bones and muscles and maintain a healthy weight.
- Using assistive devices to simplify daily tasks. Examples are luggage and grocery carts, reaching devices, shower grab bars, walking aids and low-heeled shoes.
- Maintaining a healthy weight or losing weight if necessary to reduce stress on the joints.