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Polymyalgia Rheumatica (PMR) A Guide for Patients and Families
- June Pomeroy
- 5 days ago
- 3 min read
What is Polymyalgia Rheumatica?
Polymyalgia Rheumatica is an autoimmune condition characterized by
severe muscle pain and stiffness mainly in the shoulders, neck, and hips.
Stiffness and pain are usually the worst after sleeping or resting and may be debilitating. Getting out of bed or raising your arms to brush your hair may be very difficult.
This disorder almost exclusively affects adults over the age of 50.
It is more prevalent in women than men.
Onset is usually quite sudden, over days, not months.
Flu-like symptoms such as low-grade fever, weakness, weight loss, and loss of appetite may also be present.
Giant Cell Arteritis (Horton’s disease), a closely related condition, may also occur simultaneously. This condition is an inflammation of the arteries in the head. It may present with headache, scalp tenderness, jaw pain, and visual changes, which can be a medical emergency, as blindness can result.
What Causes Polymyalgia Rheumatica?
Inflammation causes this condition, but the trigger for the inflammation is unknown.
Some studies have suggested that gene variants may play a role; however, further research is needed.
Since this disease primarily affects older adults, the aging process may be a contributing factor to its onset.
How is Polymyalgia Rheumatica Diagnosed?
Your doctor will take your medical history.
Your doctor will conduct a thorough physical examination, potentially including a check of your temporal arteries for signs of tenderness or swelling, which could indicate Horton's Disease.
Several blood tests will be drawn, such as:
* C-Reactive Protein (CRP), which measures inflammation levels.
* Erythrocyte Sedimentation Rate (ESR) is another inflammation marker.
* Antinuclear Antibody (ANA) test, which looks for antibodies that your immune
system produces against your own body's cells.
* Complete blood count (CBC) to rule out anemia or increased platelet count which often occurs with Polymyalgia Rheumatica.
*Thyroid Stimulating Hormone (TSH) to rule out hypothyroidism, which can cause weakness and sometimes pain in the shoulder and hip muscles.
*Creatine Kinase, which tests for muscle damage. There is no muscle damage with PMR, so this test result should be within the normal range.
*Rheumatoid factor and anti-cyclic citrullinated peptide antibodies. These antibodies are present in the majority of people with rheumatoid arthritis, but not in those with Polymyalgia Rheumatica (PMR). This helps the doctor distinguish between the disorders.
How is Polymyalgia Rheumatica Treated?
The primary treatment for PMR is Prednisone, a steroid. Usual dosing starts at 10-20 mg per day.
Steroids are usually very effective in quickly reducing symptoms.
Steroids are tapered after symptoms have subsided and may be discontinued after a year if symptoms allow.
Some patients will need prednisone for 2-3 years to control the symptoms.
If symptoms are not controlled with Prednisone, another class of medication called disease-modifying antirheumatic drugs (DMARDS), such as Methotrexate, may be used.
Using non-steroidal anti-inflammatory drugs (NSAIDS) such as Motrin is not helpful for PMR.
Recently, the Food and Drug Administration (FDA) has approved the use of a biologic called Kevzara (Sarilumab) for the treatment of PMR.
Living with Polymyalgia Rheumatica (PMR)
Prednisone has many potential side effects that can be worse for older adults. Be alert for:
*Increased risk of infection
*Mood swings
*Insomnia
*High blood pressure
*Vision problems such as cataracts or glaucoma
*Diabetes
*Osteoporosis (thinning, weakened bones)
*Weight gain
*Swelling of the face, legs, or other body parts
*Loss of muscle
*Bruising or thinning of the skin
Report any of the above symptoms to your doctor.
Because Giant Cell Arteritis can occur with PMR, report any headaches, vision changes, muscle pain when chewing, or fever to your doctor.
Some tips to minimize the side effects of the steroids could include:
*Engage in weight-bearing exercises, such as walking, to maintain bone density and
strength.
*Supplement with calcium and Vitamin D for bone and heart health.
*Eat a healthy diet to help prevent diabetes, high blood pressure, and weight gain.
*If you smoke, talk to your doctor about a smoking cessation program, as smoking can
affect bone and heart health.
Visit your doctor regularly and take your steroid as prescribed. Do not stop the medication quickly, as that can lead to dangerous withdrawal symptoms.
Living with Polymyalgia Rheumatica can be challenging. Talk to your doctor about recommending physical therapy, as an exercise program can help with pain management.
If you develop anxiety or depression, talk to your doctor about finding a support group or a mental health professional, as sharing your burden with others can be very healing for body, mind, and soul.
References:
Please attribute to June Pomeroy RN BSN
Assessed and Endorsed by the MedReport Medical Review Board
