Polymyalgia Rheumatica (PMR) is an inflammatory disorder that causes muscle pain and stiffness, primarily in the shoulders, neck, and hips. It is more common in older adults and can significantly impact daily activities.
Causes:
The exact cause of Polymyalgia Rheumatica is unknown, but it is believed to be an autoimmune condition, meaning the body’s immune system mistakenly attacks its own tissues. Factors that may play a role include:
- Genetics: There appears to be a genetic predisposition, as PMR is more common in people of Northern European descent.
- Age: PMR almost exclusively affects people over the age of 50, with the average age of onset around 70.
- Environmental factors: Some research suggests that environmental triggers, such as infections, might play a role in initiating the condition in genetically susceptible individuals, but no specific trigger has been definitively identified.
Symptoms:
The symptoms of Polymyalgia Rheumatica typically develop quickly, often over a few days or weeks, and can include:
- Widespread pain and stiffness: This is the hallmark symptom, affecting both sides of the body, most commonly in the shoulders, neck, upper arms, hips, and thighs.
- Morning stiffness: Stiffness is usually most severe in the morning and can last for 30 minutes or longer. It can also worsen after periods of inactivity.
- Fatigue: Significant tiredness and lack of energy are common.
- Mild fever: Some individuals may experience a low-grade fever.
- Loss of appetite and unintentional weight loss.
- General feeling of being unwell (malaise).
- Reduced range of motion: Difficulty with everyday tasks such as raising arms above the head, getting out of bed, or standing up from a chair.
PMR can sometimes occur with or precede Giant Cell Arteritis (GCA), a more serious inflammatory condition that affects the arteries, particularly those in the head. Symptoms of GCA include severe headaches, jaw pain when chewing, and vision problems, and require immediate medical attention.
Diagnosis:
Diagnosing Polymyalgia Rheumatica involves a combination of:
- Medical history and physical examination: The doctor will ask about your symptoms, their onset, and conduct a physical exam to check for tenderness and limited range of motion.
- Blood tests:
- Erythrocyte Sedimentation Rate (ESR): This test measures how quickly red blood cells settle at the bottom of a test tube. A high ESR indicates inflammation in the body.
- C-reactive protein (CRP): Another marker of inflammation. High levels of CRP are common in PMR.
- Other blood tests may be done to rule out other conditions that can cause similar symptoms, such as rheumatoid arthritis, lupus, or thyroid problems.
- Imaging tests: Imaging tests like X-rays, MRI, or ultrasound are generally not used to diagnose PMR but may be done to rule out other causes of pain.
Treatment:
Polymyalgia Rheumatica typically responds well to treatment, primarily with corticosteroids. The goal of treatment is to relieve symptoms and prevent recurrence.
- Corticosteroids:
- Low-dose oral corticosteroids (e.g., prednisone) are the most effective and common treatment. Symptoms often improve dramatically within a few days of starting treatment.
- The dose is gradually tapered over time, usually over several months to a few years, to the lowest effective dose to minimize side effects.
- Pain relievers: Over-the-counter pain relievers like ibuprofen or naproxen may be used for mild pain, but corticosteroids are usually more effective for the inflammatory pain of PMR.
- Calcium and Vitamin D supplements: Often prescribed with corticosteroids to help prevent bone loss (osteoporosis), a common side effect of long-term steroid use.
- Bone-preserving medications: Bisphosphonates may also be prescribed to protect bone density, especially with prolonged corticosteroid use.
- Physical therapy: May be recommended to help maintain muscle strength and flexibility, especially during periods of reduced activity due to pain.
- Monitoring: Regular follow-up with your doctor is essential to monitor symptoms, adjust medication dosage, and watch for potential side effects of corticosteroids or the development of Giant Cell Arteritis.
PMR is generally a self-limiting condition, meaning it often resolves on its own after a few years, but treatment is necessary to manage symptoms and prevent complications.
