Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is a relatively common inflammatory condition that causes muscle pain and stiffness, primarily in the shoulders and hips. While its exact cause remains unknown, PMR mainly affects individuals over the age of 50, with women being slightly more prone to developing the condition than men.

Polymyalgia rheumatica (PMR) is an inflammatory condition characterized by widespread pain, stiffness, or aching in large muscle groups, particularly around the shoulders, hips, lower back, neck, and thighs. The term “polymyalgia” translates to “many muscle pains,” while “rheumatica” denotes a state of flux or change.

Diagnosing PMR can be challenging as it does not typically cause swelling. Symptoms are often most pronounced in the morning and may emerge suddenly. It’s believed that PMR-related pain may stem from inflammation of the bursae, which are fluid-filled sacs that cushion joints, primarily found in the hips and shoulders. Fortunately, inflammation associated with PMR usually responds well to treatment.

Causes of Polymyalgia rheumatica

While the exact cause of PMR remains unknown, it’s believed to stem from an autoimmune response where the body mistakenly attacks its tissues. Aging, genetics, and environmental factors may also contribute to its development.

Prevalence

Polymyalgia rheumatica (PMR) primarily affects individuals over the age of 50, with the average age of onset being around 70 years old. It’s more prevalent among women, and Caucasians are at a higher risk compared to other ethnic groups.

Symptoms

Symptoms of PMR tend to manifest rapidly. Alongside muscle pain, individuals may experience:

1. Muscle Pain: Widespread pain and stiffness, particularly in the shoulders, hips, neck, and upper arms.
2. Morning Stiffness: Stiffness tends to be more severe in the morning or after periods of inactivity.
3. Fatigue: Persistent tiredness and lack of energy.
4. Occasional Fever: Some individuals may experience low-grade fever.
5. Limited Range of Motion: Difficulty in performing daily activities due to decreased range of motion in affected joints.
6. Weakness and General malaise

Temporal arteritis and your leg

Polymyalgia rheumatica (PMR) primarily affects the shoulders, hips, lower back, neck, and thighs, causing pain and stiffness. However, it typically does not affect the lower legs, as well as the lower arms, hands, and feet. Symptoms of PMR often start on one side of the body and eventually progress to both sides.

Temporal arteritis

Additionally, about 10%-20% of individuals with PMR may also develop temporal arteritis, while approximately half of those with temporal arteritis also experience PMR. Temporal arteritis, or giant cell arteritis, involves inflammation and damage to large and medium-sized arteries, including those supplying blood to the head, such as the temples.

Symptoms of temporal arteritis can include:

• Severe headaches, which are the most common symptom
• Scalp tenderness
• Jaw or facial soreness, particularly when chewing
• Changes in vision or distorted vision, resulting from reduced blood flow to the eyes
• Rarely, stroke
• Fatigue
• Fever
• Weight loss
• Night sweats
• Depression
• General feeling of illness

Risk Factors

Several factors may increase the risk of developing PMR, including:

1. Age: PMR primarily affects older adults, with the risk increasing after the age of 50.
2. Gender: Women are slightly more likely to develop PMR than men.
3. Genetics: There may be a genetic predisposition to developing PMR, although specific genes involved have not been identified.

Diagnosis of Polymyalgia rheumatica

Diagnosing PMR involves assessing specific criteria, as outlined by the American College of Rheumatology and the European League Against Rheumatism. These criteria include:

• Shoulder pain on both sides
• Morning stiffness lasting at least 45 minutes
• Elevated levels of inflammation indicated by blood tests
• Complaints of new hip pain
• Absence of swelling in the small joints of the hands and feet, as well as negative blood tests for rheumatoid arthritis

Furthermore, individuals with PMR are typically screened for temporal arteritis, a condition that involves inflammation of arteries, particularly those supplying blood to the head. This assessment begins with a thorough examination and evaluation of symptoms.

If temporal arteritis is suspected, a temporal artery biopsy may be performed to confirm the diagnosis. During this procedure, a sample is taken from the artery near the hairline, in front of the ear. While the biopsy is usually helpful, it may occasionally yield negative results despite the presence of temporal arteritis symptoms in some individuals.

Diagnosing PMR can be challenging, as its symptoms overlap with other conditions such as rheumatoid arthritis and fibromyalgia.

Treatments of Polymyalgia rheumatica

The primary goal of PMR treatment is to relieve symptoms and reduce inflammation. Treatment may include:

1. Corticosteroids: Oral corticosteroids, such as prednisone, are the mainstay of treatment for PMR. These medications help reduce inflammation and alleviate pain and stiffness.
2. Physical Therapy: Gentle exercises and stretching routines prescribed by a physical therapist can help improve flexibility and range of motion in affected joints.
3. Pain Relievers: Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), may provide additional relief from pain and discomfort.

Home Care Tips

In addition to medical treatment, individuals with PMR can also benefit from the following self-care strategies:

1. Heat Therapy: Applying heat packs or taking warm baths can help relax muscles and alleviate stiffness.
2. Regular Exercise: Engaging in low-impact exercises, such as walking or swimming, can help maintain joint flexibility and overall mobility.
3. Healthy Diet: Consuming a balanced diet rich in fruits, vegetables, and lean proteins can support overall health and well-being.

Does PMR heal without treatment?

Polymyalgia rheumatica (PMR) typically doesn’t resolve on its own without treatment. However, with proper medical care, symptoms can significantly improve over time. Here’s what to expect:

• Response to Treatment: After starting treatment, symptoms usually begin to ease within a couple of days. However, it may take a year or more, especially if there are relapses, for symptoms to completely disappear.
• Duration of Treatment: Some individuals prone to recurrent PMR may need to take low doses of steroids for life. However, for many patients, treatment can be gradually tapered and eventually discontinued once symptoms are well-controlled.
• Life Expectancy: PMR does not affect life expectancy, and most individuals with the condition can expect to resume a normal life span.

Prevention

Since the exact cause of PMR is unknown, there are no specific measures for preventing the condition. However, adopting a healthy lifestyle, including regular exercise and a balanced diet, may help reduce the risk of developing PMR or other inflammatory conditions.

Complications of Polymyalgia rheumatica

Polymyalgia rheumatica (PMR) can lead to various complications if left untreated. These may include:

1. Mobility Issues: Untreated PMR can result in decreased mobility, making everyday tasks such as bathing, dressing, and grooming challenging. It may also hinder activities like standing up or getting in and out of cars.
2. Aortic Aneurysm: In rare cases, inflammation associated with PMR can contribute to the development of an aortic aneurysm. This condition involves the weakening and bulging of the aortic wall, potentially leading to life-threatening complications.
3. Temporal Arteritis: Individuals with PMR are at increased risk of developing temporal arteritis, a condition characterized by inflammation of the arteries, particularly those supplying blood to the head. Temporal arteritis can lead to serious complications such as aortic involvement, blindness, or stroke.

Living with Polymyalgia Rheumatica

Living with PMR can be challenging, but it is highly treatable. Here are some tips for managing the condition:

1. Medication Adherence: Take prescribed medications as directed by your healthcare provider.
2. Healthy Lifestyle: Maintain a healthy diet, engage in regular exercise (while ensuring adequate rest), and utilize devices that can assist with daily activities when needed.
3. Avoid Alcohol and Smoking: Since steroids are a common treatment for PMR, it’s important to avoid alcohol and smoking, which can increase the risk of osteoporosis, a potential side effect of steroid therapy.
4. Monitoring for Complications: Stay vigilant for signs of complications, especially temporal arteritis, and promptly report any new or unusual symptoms to your doctor.

Other diseases that acts like polymyalgia

Several conditions can mimic the symptoms of polymyalgia rheumatica (PMR), leading to potential confusion during diagnosis. These include:

1. Rheumatoid Arthritis: This autoimmune condition affects the joints, causing pain, swelling, and stiffness, particularly in the hands, feet, and knees.
2. Infections: Certain infections can produce symptoms similar to PMR, such as muscle pain and fatigue.
3. Vasculitis (Inflammation of Blood Vessels): Vasculitis can cause muscle pain, especially in cases where the blood vessels supplying the muscles are affected.
4. Chemical and Hormonal Abnormalities: Imbalances in chemicals or hormones in the body can lead to muscle pain and stiffness resembling PMR symptoms.
5. Muscle Diseases: Various muscle disorders, such as myositis, can present with muscle pain and weakness similar to PMR.
6. Cancer: Some types of cancer can cause muscle pain and fatigue, potentially mimicking PMR symptoms.

Furthermore, distinguishing between PMR and other conditions, such as fibromyalgia and rheumatoid arthritis, can be challenging:

• Polymyalgia Rheumatica vs. Fibromyalgia: While both conditions involve muscle pain, PMR is believed to be an inflammatory disease, whereas fibromyalgia is characterized by heightened sensitivity to pain in the central nervous system. Fibromyalgia affects multiple areas of the body, and individuals often experience tender points in various locations.
• Polymyalgia Rheumatica vs. Rheumatoid Arthritis: Both conditions primarily affect older adults, but they differ in their symptom presentation. PMR typically causes morning stiffness and muscle pain around the shoulders and hips, while rheumatoid arthritis is characterized by joint swelling, particularly in the hands, feet, and knees. However, distinguishing between the two can be challenging for healthcare providers.

Given the overlapping symptoms and complexities involved, accurate diagnosis of PMR often requires thorough evaluation by a healthcare professional, including a comprehensive medical history, physical examination, and appropriate diagnostic tests.

When to See a Doctor

It is essential to consult a healthcare provider if you experience persistent muscle pain, stiffness, or other symptoms suggestive of PMR. Early diagnosis and treatment can help manage symptoms more effectively and prevent complications.

Outlook/Prognosis

With appropriate treatment, most individuals with PMR experience significant improvement in symptoms within a few weeks to months. However, treatment with corticosteroids may be necessary for an extended period to prevent disease flare-ups. In some cases, PMR may resolve on its own over time, but recurrence is possible.

Sources

1. Mayo Clinic. “Polymyalgia rheumatica.
2. American College of Rheumatology. “Polymyalgia Rheumatica.”