Polymyalgia Rheumatica

Polymyalgia rheumatica is a condition that causes muscle pain and stiffness, mainly in the shoulders and hips. This pain and stiffness often appear quickly and are typically worse first thing in the morning.

People who get polymyalgia rheumatica are usually over 65 years old. It's less common in people under 50.

This condition is connected to another inflammatory problem called giant cell arteritis. Giant cell arteritis can cause various symptoms, including headaches, trouble seeing clearly, pain in the jaw, and tenderness on the scalp. It's possible for someone to have both polymyalgia rheumatica and giant cell arteritis at the same time.

Polymyalgia rheumatica often causes pain and stiffness on both sides of the body. Common symptoms include:

• Pain: You might feel aches in your shoulders, neck, upper arms, buttocks, hips, and thighs.
• Stiffness: This stiffness is frequently worse in the morning or after periods of inactivity. The affected areas, like your shoulders, neck, and hips, might feel tight and difficult to move.
• Limited Movement: You may find it harder to move your arms, legs, or other affected joints as much as you usually can.
• Joint Pain: You could also experience pain or stiffness in your wrists, elbows, or knees.

Along with these localized symptoms, you might also notice some more general signs of illness, such as:

• Mild Fever: A slightly elevated body temperature.
• Fatigue: Feeling unusually tired and worn out.
• Feeling unwell (malaise): A general sense of discomfort and illness.
• Loss of Appetite: Not feeling hungry or having a reduced desire to eat.
• Weight Loss: Losing weight without trying to. This can be a subtle sign but important to note.
• Depression: Feeling down or sad, which can be a symptom of this condition.

If you experience several of these symptoms, it's important to talk to your doctor. Early diagnosis and treatment can help manage the condition effectively.

If you're experiencing new aches, pains, or stiffness that's affecting your daily life, see a doctor. This is especially important if:

• It's a new problem: If you've never had these symptoms before, it's crucial to get checked out. A new pain could signal a serious issue that needs prompt attention.
• It's interfering with your sleep: Constant aches and pains can make it hard to fall asleep or stay asleep. If this is happening, it's a sign something might be wrong and needs medical evaluation. Poor sleep can also worsen existing health conditions.
• It's making it hard to do everyday tasks: If you're having trouble with simple activities like getting dressed, showering, or walking, see a doctor. This could be a sign of a condition that needs treatment to improve your quality of life and prevent further complications.

Polymyalgia rheumatica (PMR) is a condition where people experience pain and stiffness in their shoulders and hips. Scientists don't know exactly what causes it. However, two main things seem to contribute:

• Your genes: Certain genes or variations in your genes might make you more likely to get PMR. Think of it like having a predisposition. Just because you have these genes doesn't mean you'll definitely get PMR, but they increase your chance.

• Things in your environment: Cases of PMR sometimes appear in waves, or cycles, possibly linked to the seasons. This suggests that something in the environment might trigger the condition. For example, it could be a virus. However, scientists haven't pinpointed a specific virus that causes PMR. It's likely a combination of factors, rather than a single cause. Perhaps a virus or another environmental trigger interacts with your genes to lead to PMR.

Polymyalgia rheumatica (PMR) is a condition that mainly affects older adults. Several factors increase a person's chances of getting PMR.

Age: Most people diagnosed with PMR are over 50, and the peak age range is typically between 70 and 80. This means that if you're younger than 50, you're less likely to get PMR.

Gender: Women are more likely to develop PMR than men. In fact, women are roughly two to three times more prone to getting this condition compared to men. This difference in risk is important to note.

Ethnicity: PMR is more common in people of white European descent, particularly those with ancestors from Scandinavia or northern Europe. While this doesn't mean other groups can't get it, their risk is higher than average. It's important to remember that anyone can develop PMR, but these factors can influence the likelihood.

Polymyalgia rheumatica (PMR) can make simple daily tasks hard. For example, getting up from a chair, getting out of bed, or even getting out of a car can be painful and challenging. Similar difficulties can happen when trying to comb your hair, bathe, or get dressed. These problems can impact your overall health and well-being in several ways. You might find it harder to socialize, exercise, or get enough sleep. Your daily routines and quality of life can be significantly affected.

To figure out what's causing your pain and stiffness, your doctor will do a physical exam. This includes checking your joints and nervous system. They might gently move your head and limbs to see how far you can move them (your range of motion). Lab tests and imaging are also important.

Your doctor might change your diagnosis as your treatment goes on. Sometimes, people initially diagnosed with polymyalgia rheumatica (PMR) are later found to have rheumatoid arthritis (RA). This is why it's important to work closely with your doctor.

To help diagnose PMR, your doctor might suggest these tests:

Blood Tests: Your doctor will check your blood to see if you have any signs of inflammation. This involves looking at your complete blood count (CBC) and two markers of inflammation: erythrocyte sedimentation rate (ESR), often called "sed rate," and C-reactive protein (CRP). Important note: in some people with PMR, these tests might be normal or only slightly elevated.

Imaging Tests: Ultrasound is becoming a more common tool to tell PMR apart from other conditions with similar symptoms. MRI scans can also help identify other possible causes of shoulder pain, such as problems with the joints themselves.

Important Signs to Watch For (Giant Cell Arteritis): It's crucial to tell your doctor right away if you notice any of these symptoms, as they might indicate giant cell arteritis (GCA), a serious condition that can affect blood vessels. GCA is often associated with PMR.

• New, unusual or persistent headaches: If you get a headache you've never had before, or one that won't go away, tell your doctor.
• Jaw pain or tenderness: Pain or soreness in your jaw could be a sign of GCA.
• Blurred or double vision, or loss of vision: Any changes in your vision should be checked by your doctor immediately.
• Scalp tenderness: If your scalp hurts, let your doctor know.

If your doctor suspects GCA: A biopsy of a temple artery is often done. This involves removing a small piece of the artery under local anesthesia, so you won't feel much pain during the procedure. The sample is then looked at under a microscope to check for inflammation.

Treating Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is typically treated with medicine to help reduce pain and stiffness. Unfortunately, relapses (where symptoms return) are common.

Corticosteroids: A Common Treatment

The most common treatment for PMR is a low dose of oral corticosteroids, like prednisone. You might start feeling better within a few days, noticing a decrease in pain and stiffness.

After a few weeks (2-4), your doctor will likely start to gradually lower the dose. This is important because while corticosteroids are helpful, they can have side effects. The goal is to use the lowest dose possible that prevents symptoms from returning.

Most people with PMR need to take corticosteroids for a year or longer. Regular check-ups with your doctor are crucial to monitor how the treatment is working and to watch for any side effects.

Potential Side Effects of Corticosteroids

Long-term use of corticosteroids can lead to some serious side effects. These include weight gain, weaker bones (osteoporosis), higher blood pressure, diabetes, and even eye problems like cataracts. Your doctor will closely monitor you for any of these issues and may adjust the dose or prescribe other medications to manage side effects.

Returning to Normal Activities

Many people with PMR return to their usual activities after treatment. However, if you've been less active for a while, physical therapy can be very helpful in regaining strength and flexibility. Talk to your doctor about whether physical therapy would be beneficial for you.

Additional Supportive Treatments

• Calcium and Vitamin D: To help prevent bone loss from corticosteroids, your doctor will likely recommend daily calcium and vitamin D supplements. The recommended daily amounts are generally 1000-1200 milligrams of calcium and 600-800 international units (IU) of vitamin D, especially if you've been taking corticosteroids for three months or more. This is often advised by the American College of Rheumatology.

• Methotrexate (Trexall): Sometimes, doctors combine methotrexate with corticosteroids. Methotrexate is a medicine that helps to reduce the activity of your immune system. It's taken by mouth. Your doctor might suggest methotrexate if you have a relapse or don't respond well to corticosteroids, or even early in the treatment process. This is often discussed in joint guidelines from the American College of Rheumatology and the European League Against Rheumatism.

Important Note: This information is for general knowledge and does not constitute medical advice. Always discuss any health concerns or treatment options with your doctor.

Pain relievers like ibuprofen (Advil, Motrin) and naproxen (Aleve) aren't typically the best choice for managing polymyalgia rheumatica (PMR). Doctors usually recommend other treatments for PMR.

While you're taking medicine for PMR, healthy habits can help you feel better and manage any side effects. These are important for your overall health, not just the medicine's side effects:

• Healthy eating: Focus on foods like fruits, vegetables, whole grains, and lean protein and dairy. Try to eat less salt (sodium). Too much salt can cause your body to hold onto water, which can lead to swelling and high blood pressure.

• Regular exercise: Talk to your doctor about safe and effective exercises for you. Exercise helps you stay at a healthy weight, and it can strengthen your bones and muscles, making everyday activities easier.

• Adequate rest: Your body needs rest to recover from daily activities and exercise. Make sure you're getting enough sleep and taking breaks when you need them.

• Assistive devices: Using tools like shopping carts, reachers, grab bars in the shower, and other assistive devices can make everyday tasks easier and safer, reducing strain on your body. This can be especially helpful in managing pain and discomfort.