Polymyalgia rheumatic

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

The term “polymyalgia rheumatic” is sometimes used to mean polymyalgia rheumatica (PMR). This is a common inflammatory condition that causes aches and pains as well as stiffness in the neck, shoulders, and hips.

It is a disease that usually affects people who are over the age of 50.

The cause is unknown. Biopsy of affected joints has shown the presence of synovitis (inflammation of the joint lining).

PMR is more common in women than men and is more common in people of Northern European ancestry.

Symptoms begin slowly with aching and stiffness in the neck, shoulders, and hips. Morning stiffness, as well as stiffness during the day with inactivity, is characteristic. The stiffness is accompanied by a deep aching. Patients will have difficulty getting out of bed or out of a chair because of pain.

Other symptoms including fatigue, weight loss, low grade fever, loss of appetite, depression, and night sweats may be seen. Swelling in the knees, wrists, and hands may suggest the diagnosis of rheumatoid arthritis. And in fact, there may be little or no difference between the two conditions as far as treatment is concerned in some patients.

Twenty per cent of patients with PMR may have concurrent giant cell arteritis, a form of vasculitis, that leads to blindness. Patients with PMR who complain of headaches, tenderness of the scalp, or pain in the jaw and a tired feeling with chewing (jaw claudication) should have a temporal artery biopsy.

Laboratory tests will show a markedly elevated erythrocyte sedimentation rate (ESR). Anemia, elevated white blood cell count, elevated platelet count, and abnormal liver function tests may be seen.

Treatment of PMR consists of prednisone in a dose of 10 to 20 mgs/day. A significant response to this drug within 48 hours is helpful as a diagnostic test.

After symptoms are controlled, prednisone may be slowly tapered. Since patients will be on prednisone for about 1 to 2 years, steroid sparing drugs such as methotrexate might be considered.

It is not uncommon for patients to flare during steroid taper. The flare is treated with upward adjustments of corticosteroid dose.

While this disease may cause a tremendous amount of discomfort, it is generally not life-threatening. The major considerations have to do with making the right diagnosis, and tapering prednisone slowly while being cognizant of steroid side-effects.

Also being aware of the association with temporal arteritis is important as well.

Patients should receive osteoporosis prophylaxis if their steroid doses remain relatively high.

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