POLYMYALGIA RHEUMATICA
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POLYMYALGIA RHEUMATICA
Polymyalgia Rheumatica
Polymyalgia rheumatica is the most frequent inflammatory disease of musculoskeletal system after age 50.
What is polymyalgia rheumatica?
Polymyalgia rheumatica (PMR) is a type of inflammatory disorder that causes muscle pain and stiffness, particularly in the shoulders, neck, and hips. The condition most commonly affects adults over the age of 50 and is more common in women than men.
Symptoms of PMR usually develop quickly over a period of weeks or months and may include pain and stiffness in the affected areas, fatigue, and low-grade fever. The pain and stiffness can be severe enough to interfere with daily activities such as dressing, grooming, and getting out of bed.
The exact cause of PMR is not known, but it is thought to be an autoimmune disorder, in which the body’s immune system attacks its own tissues. Treatment for PMR typically involves the use of corticosteroid medications, which can help reduce inflammation and relieve symptoms. With proper treatment, most people with PMR are able to achieve remission and maintain a good quality of life.
The main symptoms:
The main feature of the polymyalgia rheumatica is a discrepancy between the pain intensity and objective symptoms examined by rheumatologist.
Polymyalgia rheumatica can cause pain and stiffness of the large muscles around the shoulders, hips, low and upper extremities. The muscles around the neck may also be affected.
The stiffness may be so severe that dressing, reaching, washing, climbing stairs, raising your arms above shoulder height (for example, to comb your hair) or even getting out of bed or a chair may be difficult. The pain may also wake you at night. The pain and stiffness from polymyalgia rheumatica is often widespread, and is worse in the morning, when resting or after rest. Symptoms can improve with activity or at the end of the day. At times, tiredness can be overwhelming, this is known as fatigue. The condition can also make you feel anxious and depressed.
It’s also common to have slight fever like 37.2-37.5-degree, weight lose because of appetites loss, depression, anxiety and sleep disturbance. Inflammation and swelling sometimes can affected the joints and tendons (tenosynovitis), but intensity of arthritis is mild.
The symptoms can start insidiously or just after viral infection (flu-like illness), typically developed their maximum over a few days or weeks.
Diagnosis:
There are no specific lab tests to diagnose polymyalgia rheumatica. Usually rheumatologist makes the diagnosis based on clinical symptoms. Typically, making diagnosis takes too much time because of low awareness by GP and other medical specialists.
The diagnostic criteria are:
- Age above 50
- New shoulder, neck, hip or thigh pain on both sides of the body, which has been present for at least two weeks
- Pain and stiff muscles in the shoulders, hips or thighs in the mornings that lasts at least 30 minutes
- Increase ESR and CRP
Treatment:
The main treatment is steroids (prednisone, prednisolone) in average doses 10-25 mg per day. The treatment period usually takes 2 years. Before and during the treatment period you have to be under careful supervision of your rheumatologist.
Polymyalgia rheumatica (PMR) is typically treated with corticosteroid medications, such as prednisone. These medications are effective in reducing inflammation and relieving pain and stiffness associated with the condition.
The initial dose of prednisone is typically between 10 and 20 milligrams per day, and it may take several weeks to achieve full symptom relief. Once symptoms are under control, the dose can be gradually reduced over several months.
In addition to medication, gentle exercise and physical therapy can also be helpful in managing PMR symptoms. Stretching and low-impact activities, such as walking or swimming, can help improve flexibility and reduce pain and stiffness.
It’s important to work closely with a healthcare provider to develop an individualized treatment plan for PMR, as the optimal dosage and duration of treatment can vary depending on the individual’s age, overall health, and the severity of the condition. Regular monitoring is also important to ensure that the medication is working effectively and to monitor for potential side effects of corticosteroid treatment.
Treatments
Inflammatory arthritis:
- Rheumatoid arthritis
- Juvenile rheumatoid arthritis in adults
- Psoriatic arthritis
- Ankylosing Spondylitis
- Adult-Onset Still’s Disease
Systemic diseases:
- Systemic Lupus Erythematosus (SLE)
- Scleroderma
- Syndrome Raynaud’s
- Sjogren Syndrome
Crystal arthritis:
- Gout and Pseudogout
Systemic Vasculitis:
- Giant cell arteritis
- Takayasu arteritis
- Granulomatosis with polyangiitis (Wegener’s)
- EGPA (Churg-Strauss syndrome)
- Polyarteritis nodosa
Degenerative and metabolic diseases:
- Osteoarthritis
- Osteoporosis
- Expert at the area of biologic therapy of the autoimmune diseases