Polymyalgia Rheumatica

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Polymyalgia Rheumatica (PMR), an inflammatory disorder that causes widespread muscle aching and stiffness, primarily in your neck, shoulders, upper arms, thighs and hips.

Although some people develop these symptoms gradually, polymyalgia rheumatica can literally appear overnight. People with PMR may go to bed feeling fine, only to awaken with stiffness and pain the next morning.

Just what triggers this disease isn't known, but the cause may be a problem with the immune system, perhaps involving both genetic and environmental factors. Aging also appears to play a role — PMR almost always develops in people age 50 and older.

Polymyalgia rheumatica usually goes away on its own in a year or two — often as mysteriously as it came. But you don't have to endure the pain and disabling effects of PMR for months or years. Medications and self-care measures can improve your symptoms.

PMR causes moderate to severe aching and stiffness in the muscles in your hips, thighs, shoulders, upper arms and neck. Initially, you may have pain on just one side of your body, but as the disease progresses, symptoms are likely to occur on both sides.

Stiffness is usually worse in the morning or after sitting or lying down for long periods. At times, the discomfort also may be severe enough to wake you at night.

The aching and stiffness of PMR often occur suddenly, but sometimes may develop gradually. Polymyalgia rheumatica can cause other signs and symptoms including:

  • Fatigue
  • Unintentional weight loss
  • Weakness or a general feeling of being unwell
  • Sometimes, a slight fever
  • low red blood cell count

  • In the United States, approximately 15 percent of people with PMR have a related condition called giant cell arteritis, which causes the arteries in your temples and sometimes in your neck and arms to become swollen and inflamed.

    PMR is an arthritic syndrome that causes your muscles to feel achy and stiff due to mild inflammation in your joints and surrounding tissues. Most of the inflammation occurs in the hip and shoulder joints, but it may develop elsewhere in your body as well. In general, the inflammation isn't as severe as that in inflammatory types of arthritis, such as rheumatoid arthritis.

    In PMR, inflammation occurs when white blood cells — which normally protect your body from invading viruses and bacteria — attack the lining of your joints. Researchers aren't sure what causes this abnormal immune system response, but they suspect that as with many disorders, both genetic and environmental factors are involved.

    There may be a link between polymyalgia rheumatica and certain viruses, such as adenovirus, which causes respiratory infections ranging from the common cold to pneumonia; human parvovirus B19, the source of an infection that primarily affects children; and human parainfluenza virus.

    Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin, others) can be effective in treating mild symptoms of PMR, although long-term use can cause stomach and intestinal bleeding, fluid retention, high blood pressure, renal insufficiency, worsening congestive heart failure, liver function test abnormalities, and possible cognitive changes.

    . . . Corticosteroids
    For more severe cases, the usual treatment for PMR is a low, daily dose of an oral corticosteroid drug such as prednisone. Relief should be almost immediate. If you're not feeling better in a few days, it's likely you don't have polymyalgia rheumatica. In fact, your response to medication is one way your doctor may confirm the diagnosis.

    After the first month, when your sed rate and platelet count have normalized, and any anemia is improved, your doctor will gradually start lowering the amount of cortisone you take until you reach the lowest possible dosage needed to control inflammation. Some of your symptoms may return during this tapering-off period.

    The amount of time on medication varies from person to person. Most people are able to discontinue steroids within two years. Don't stop taking this medication on your own, however. Because corticosteroids suppress your body's natural production of cortisone, stopping suddenly can make you very ill.

    At the same time, taking steroids, even in low doses, for long periods can lead to a number of side effects. This is especially true for older adults — those most likely to be treated for PMR. That's because they're more prone to develop certain conditions that also may be caused by corticosteroids, such as:

  • Osteoporosis This condition causes bones to become so weak and brittle that even slight movements such as bending over, lifting a vacuum cleaner or coughing can cause a fracture. Older women are most at risk of osteoporosis, and taking steroid medications increases the risk. For this reason, your doctor is likely to monitor your bone density and may prescribe calcium and vitamin D supplements or other medications to help prevent bone loss.

  • High blood pressure Long-term corticosteroid use can also raise blood pressure. For that reason, your doctor is likely to monitor your blood pressure and may recommend an exercise program, diet changes and sometimes medication to keep blood pressure within a normal range.

  • Cataracts Cortisone increases your risk of cataracts, a condition that causes the lens of the eye to become cloudy, impairing vision.

  • Other possible side effects of cortisone therapy include weight gain, decreased immune system function — making you more prone to infections — muscle weakness and high blood sugar levels, which may increase your risk of diabetes or worsen diabetes you already have.

    Because of these risks, researchers are investigating other medications to treat PMR. Researchers have reported some success with a combination of the drug methotrexate and corticosteroids. People on this combination were able to stop taking steroids sooner.

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    ...less medical jargon in a 'Quick Glance' format!