What is polymyalgia rheumatica?
Polymyalgia rheumatica is an inflammatory syndrome characterized by severe pain and stiffness in the proximal musculature of arms and legs. There is no associated weakness in the muscles.
It is currently believed that polymyalgia rheumatica may be associated with underlying inflammation in blood vessels.
The name polymyalgia rheumatica has its roots in Greek words. In Greek 'poly' means 'many', 'my' refers to ' muscle' and 'algia' means 'pain' (many muscle pain) and 'rheumatica'refers to 'muscle and soft tissue'.
There is a rare (less than 5%) association with another syndrome called giant cell arteritis. This syndrome causes inflammation in the blood vessels on the scalp and in the vessels leading to the brain. The inflammation in these blood vessels can lead to narrowing and reduced blood supply distal to the narrowing. This can cause loss of vision in an eye and rarely other blockages.
How common is polymyalgia rheumatica?
Polymyalgia rheumatica predominantly affects individuals over the age of 50. Giant cell arteritis affects men and women over the age of 50 who may or may not have polymyalgia rheumatica. The incidence of PMR is 1:133 people over the age of 50 with peak incidence between ages 70-80. Giant cell arteritis affects 17 pts/100,000 individuals over age 50.
Warning signs of polymyalgia rheumatica
- Pain and stiffness in neck,shoulders, hips and thighs
- Morning stiffness in these areas lasting more than 1 hour
- Low energy and fatigue
- Anemia (pronounced a-nee-mee-a) causing low blood that can cause patient to be pale, weak, dizzy and easily fatigued
- Poor appetite and weight loss
WARNING SIGNS OF GIANT CELL ARTERITIS
The initial sign is a steady unrelenting headache localized over the side of the skull. There may be tenderness and prominence of the blood vessel at the side of the head in front of the ear. Other symptoms may include changes in the vision of an eye or sudden loss of vision in an eye. There can be pain in the muscles used for chewing.
Patients who have PMR that develop these symptoms should contact their doctor or go to the emergency department for attention.
What causes polymyalgia rheumatica?
No one knows for sure what causes PMR. There may be some genetic factors.
What can you do about polymyalgia rheumatica?
Your doctor will do a history and physical exam. There will be blood tests done to rule out other causes of muscle pain and to determine if there is presence of inflammation. One test for inflammation called an erythrocyte sedimentation rate (ESR) will be elevated in the vast majority of cases (usually higher than 50).
To diagnose giant cell arteritis often requires a biopsy of a portion of the Temporal artery. The biopsy specimen will be examined under a microscope to search for characteristic changes that are diagnostic.
Treatment of PMR and GCA
Cortisone is most often the treatment of choice for these conditions. This is a potent anti-inflammatory medication that will settle the inflammatory conditions. A higher dose is required for GCA. Prednisone is the most common type of cortisone used. This medication is taken by pill form and the best time of day to take these pills is in the morning. After initiating a high dose to control the inflammation and the ESR returns to normal the dose is slowly reduced to a maintainance dose to prevent inflammation from reoccurring. This maintainance dose is used for a minimum of 1 year and may be required for several years. If too high a dose is required other immunosuppressive drugs may be added to help lower the dose (eg methotrexate).
After adequate treatment (minimum 1 year) the disease may settle and allow the prednisone to be withdrawn. If the symptoms recur then treatment is resumed and withdrawal may be attemted every 6 months until it can be successfully stopped and there is no recurrence.