Summary about Disease
Polymyalgia rheumatica (PMR) is an inflammatory disorder that causes muscle pain and stiffness, particularly in the shoulders, neck, hips, and thighs. It often develops rapidly, over a period of days or weeks. PMR is closely related to another inflammatory condition called giant cell arteritis (GCA). Many people with GCA also have PMR. PMR primarily affects older adults, rarely occurring in people under 50 years of age.
Symptoms
The primary symptoms of polymyalgia rheumatica are:
Aches and stiffness: Muscle pain and stiffness, often severe, in the neck, shoulders, upper arms, hips, and thighs. Stiffness is usually worse in the morning or after periods of inactivity.
Limited range of motion: Pain can restrict the ability to move affected joints.
General symptoms: Fatigue, mild fever, loss of appetite, weight loss, and a general feeling of being unwell (malaise).
Other possible symptoms: Occasionally, PMR may be associated with carpal tunnel syndrome, swelling in the wrists or ankles, or depression.
Causes
The exact cause of polymyalgia rheumatica is unknown. Genetic factors and environmental triggers may play a role. Some research suggests a possible link to viral infections. It is believed to be an autoimmune condition where the body's immune system mistakenly attacks its own tissues.
Medicine Used
The main treatment for polymyalgia rheumatica is corticosteroids, such as prednisone. The dosage is usually started at a moderate level and gradually reduced as symptoms improve. Other medications like methotrexate may be used as steroid-sparing agents to minimize long-term steroid side effects. Pain relievers such as NSAIDs are not very effective.
Is Communicable
Polymyalgia rheumatica is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
While there is no known way to prevent PMR, certain precautions can help manage the condition and its treatment:
Follow your doctor's instructions: Adhere to your prescribed medication schedule and dosage.
Monitor for side effects: Be aware of potential side effects of corticosteroids (e.g., weight gain, mood changes, increased blood sugar) and report any concerns to your doctor.
Healthy lifestyle: Maintain a healthy diet, engage in regular exercise (as tolerated), and get enough sleep. This can help manage symptoms and side effects of medications.
Calcium and Vitamin D: Consider taking calcium and vitamin D supplements to help prevent bone loss, a common side effect of long-term steroid use.
Bone density screening: Periodic bone density scans may be recommended to monitor for osteoporosis.
How long does an outbreak last?
Without treatment, polymyalgia rheumatica can last for several months to years. With corticosteroid treatment, symptoms usually improve dramatically within days to weeks. The duration of treatment varies depending on the individual and the severity of the condition, but it commonly lasts for 1-2 years or longer, with gradual tapering of the medication under medical supervision. Relapses (flare-ups of symptoms) can occur, even during treatment.
How is it diagnosed?
Diagnosis of polymyalgia rheumatica is primarily based on:
Medical history and physical examination: The doctor will ask about symptoms, medical history, and perform a physical exam to assess range of motion and tenderness.
Blood tests: Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are common findings, indicating inflammation in the body. Complete blood count to rule out other conditions.
Ruling out other conditions: It's essential to rule out other conditions that can cause similar symptoms, such as rheumatoid arthritis, lupus, or fibromyalgia.
Response to corticosteroids: A rapid and significant improvement in symptoms after starting corticosteroids is a strong indicator of PMR.
Imaging Studies Imaging is not typically used to diagnose PMR, but may be used to rule out other conditions.
Timeline of Symptoms
Onset: Symptoms typically develop rapidly, often over a period of days or weeks.
Early symptoms: Muscle aches and stiffness, particularly in the shoulders, neck, hips, and thighs, are usually the first symptoms.
Progression: Symptoms worsen over time, leading to limited range of motion, fatigue, and general malaise.
Treatment response: With corticosteroid treatment, most people experience significant improvement within days to weeks.
Maintenance: The dosage of corticosteroids is gradually reduced over time to minimize side effects.
Relapses: Symptoms may recur (relapse) during or after treatment.
Important Considerations
Giant Cell Arteritis (GCA): Because PMR is closely associated with GCA, it's crucial to monitor for symptoms of GCA (e.g., headache, vision changes, jaw pain) and report them to your doctor immediately. GCA can lead to serious complications, including blindness.
Long-term Corticosteroid Use: Prolonged use of corticosteroids can cause side effects such as weight gain, high blood sugar, osteoporosis, and increased risk of infection. It's important to discuss these risks with your doctor and take steps to minimize them (e.g., calcium and vitamin D supplementation, regular exercise, monitoring blood sugar).
Individualized Treatment: The treatment plan should be tailored to each individual's needs and response to medication. Regular follow-up appointments with your doctor are essential to monitor your condition and adjust the treatment plan as needed.
Support: Living with a chronic condition like PMR can be challenging. Seek support from family, friends, or support groups to cope with the physical and emotional aspects of the condition.