Positioning Yourself Away From Polymyalgia Rheumatica
You recently turned 60 years old. You are experiencing severe aching, stiffness and pain in your shoulders, arms, hips and legs. Within several weeks, you have gone from walking and exercising daily to not being able to get out of bed or even comb your hair. You may have polymyalgia rheumatica.
Polymyalgia rheumatica (PMR) meaning pain in many muscles (poly meaning many; myo meaning muscle; algia meaning pain) is not a new disease. PMR has been diagnosed for more than 100 years and usually affects people over age 50. PMR is almost exclusively reported in whites and is more prominent in women. Although no one knows the exact cause of this disease, aging, infection and genetics seem to play an important role.
Patients with PMR experience severe muscle pain and stiffness usually in the neck, shoulders, thighs and hips. PMR onsets can be either sudden or progressive, and patients can feel fine one day and terrible the next. Raising an affected arm causes pain, as does climbing stairs. There also might be generalized fatigue, fever and unexplained weight loss.
No one can say what sets off the muscle-joint problem, but inflammation is very much a part of it. A laboratory finding, the erythrocyte sedimentation rate is almost always very elevated (92-94 percent) in PMR. A different blood test for inflammation, C-reactive protein, is abnormal in 99 percent of people with the condition.
While PMR is a painful disease, it is neither life-threatening nor life-shortening. We cannot accurately predict the course of the ailment. Once it starts, it can last from six months to a year, but episodes lasting five years or more are not uncommon.
PMR is considered a form of arthritis. Using special imaging techniques, researchers can determine whether there is inflammation in the hip and shoulder joints, although the joints do not appear swollen in typical cases. This can make the diagnosis challenging because the physical examination may be completely normal. Despite considerable muscle symptoms, blood tests do not reveal evidence of muscle damage (high muscle enzymes). Fortunately, other tests that detect inflammation are quite elevated in most cases. The most common of these tests is the erythrocyte sedimentation rate or “sed rate.”
One of the frightening aspects of PMR is the bad company it can keep, particularly temporal arteritis, a sometimes dangerous inflammation of certain arteries, including those of the eyes. The threat of blindness makes early treatment urgent as a means of preserving the health of those vessels.
If PMR is suspected, the diagnosis can almost always be confirmed by a trial of corticosteroids, typically prednisone. If the individual has PMR, the response to treatment is often dramatic, giving marked relief in 24 to 48 hours. If symptoms cannot be controlled with corticosteroids in a week’s time, the diagnosis should be questioned. When symptoms have abated, and the sed rate has normalized, the corticosteroids can be gradually decreased. The rate of decrease is variable and depends on the individual’s symptoms and laboratories. Corticosteroids should never be stopped abruptly. Most individuals will require one to three years of treatment before PMR resolves. Occasionally PMR will transition into a form of inflammatory arthritis that will require long-term treatment.
Rest and exercise are important components to recovery. Some good forms of exercise include riding a bicycle, walking, and swimming.
Some people report improvement when they switch to a low-inflammation diet, such as the Mediterranean or DASH diets. Foods that are associated with anti-inflammatory properties include leafy greens, fruit, nuts, whole grains, fatty fish and green tea.
If you suspect that you might have PMR, consult your healthcare provider. Dealing with PMR can be exhausting, but with the right treatment you can lead an active life.
