Polymyalgia Rheumatica

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Polymyalgia Rheumatica is a rare inflammatory disease characterized by muscle pain (also known as myalgia), stiffness, and additional generalized systemic symptoms such as fatigue and low-grade fever. This condition often causes muscle pain in the shoulders, hips, arms, and in the neck of a patient. In addition, Polymyalgia Rheumatica begins over time, however, this condition is known to start much more rapidly overnight. Fortunately, with treatment, Polymyalgia Rheumatica is usually treated for about 2 years, though studies have shown that it can last up to 7 years. Unlike other forms of joint inflammatory conditions, Polymyalgia Rheumatica does not cause progressive or permanent damage or disability to the muscles and joints.

Polymyalgia Rheumatica is closely related to ‘giant cell arteritis’, another inflammatory disorder. Giant cell arteritis causes certain arteries to become inflamed, red, hot, or painful. It usually affects the arteries above and in front of the ears on both sides of the head. This type of condition is also sometimes called ‘temporal arteritis’ or ‘cranial arteritis’. These two disorders have been described in the medical literature as possible variants of the same disease process. Studies have shown that they represent different ends of a disease continuum.

Causes & Symptoms

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The causes associated with PMR (Polymyalgia Rheumatica) aren’t clearly known. However, it is believed that certain genes and gene variations can increase the chance of developing PMR. Some environmental factors may also play a role in the early stages of the condition. Additionally, new cases of Polymyalgia Rheumatica are often diagnosed in cycles and normally occur seasonally. Therefore, this suggests that there may be an environmental trigger, such as a viral infection, that leads to Polymyalgia Rheumatica.

Certain symptoms of Polymyalgia Rheumatica can affect an individual either suddenly or more insidiously. Therefore, the most common symptoms of PMR include:

 

  • Severe pain – This usually starts in the shoulders and is typically described as a muscle ache similar to the flu or excessive exercises. The pain may eventually spread over to the neck and hip regions.
  • Stiffness in the morning – Morning stiffness can last for hours in the early courses of Polymyalgia Rheumatica. Stiffening of joints due to immobility, or long periods of resting can also occur later in the day. In severe cases, the stiffness may last for an entire day.
  • Difficulty performing regular activities – This can occur when you are rising from bed, walking regularly, or raising your arms to comb your hair. Climbing stairs or getting in and out of a car can also be painful.
  • Tiredness – This may resemble having the flu that lasts for weeks and maybe even for months.
  • Symmetrical joint pain – Symmetrical joint pain is often seen in Polymyalgia Rheumatica affecting both the right and left sides (for instance, both shoulders and both hips).

Other symptoms of Polymyalgia Rheumatica may appear later as the inflammation in the joints worsen. Decreased appetite leading to weight loss is a possible symptom in the mid-courses of PMR. In addition, swelling and fluid inflammation causing pitting edema or swelling without pitting edema is another possibility.

In more severe cases, Polymyalgia Rheumatica can have an adverse effect on mental health. For example, patients who have PMR may experience the following:

 

  • Depression resulting from loss of physical activity.
  • A sudden decline in physical well-being, leading to the feeling of aging faster.
  • Low self-esteem due to sudden loss of weight.

Several potential causes for Polymyalgia Rheumatica are currently being investigated – some of these causes include:

 

  • Infection – The sudden start of Polymyalgia Rheumatica and the nature of the symptoms like joint pain, fever, and malaise, are suspected to be a result of infections caused by viruses.
  • Immunology – Blood tests indicate immune system cells penetrating the synovial membrane of joints and tendons, resulting in inflammation. This is similar to the autoimmune process in which the body tissues are attacked by its own immune system.
  • Genetic predisposition – A specific gene called HLA-DR4 that is associated with rheumatoid arthritis is also present in many cases where Polymyalgia Rheumatica and giant cell arteritis occur together.

Environmental factors – Damage of superficial arteries by over-exposure to ultraviolet radiation from the sun is another proposed cause for the development of PMR. Some studies suggest the elastic fibers present in the arteries and synovial membranes are damaged by ultraviolet rays. These damaged tissues may get infected by viruses that remain dormant for a long time and may get reactivated later, causing Polymyalgia Rheumatica.

Who gets Polymyalgia Rheumatica?

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Some risk factors are associated with Polymyalgia Rheumatica. These factors are described below:

 

  • Genetics – Certain genes and / or gene variations may increase your chance of Polymyalgia Rheumatica.
  • Age – The risk of Polymyalgia Rheumatica is known to increase with age. The condition is rarely seen in people under the age of 50. Most of these cases involve patients 75 years and older.
  • Gender – Women are 2-3 times more likely to be affected by Polymyalgia Rheumatica than men.
  • Ethnicity – People of any ethnicity can develop Polymyalgia Rheumatica.

How Does it Affect You? How Serious is it?

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Several diagnostic imaging tests such as magnetic resonance imaging (MRI) and positron emission tomography (PET) scans present a detailed picture of what goes on in the anatomy of the affected joints during the development of Polymyalgia Rheumatica. Imaging shows inflammation of synovial membrane tissue that is commonly found in bursae, joints, and tendons. This inflammation causes pain, therefore, the main types of inflammation associated with Polymyalgia Rheumatica include:

 

Synovitis

The shoulder and hip joints may be affected by a condition called synovitis. A normal synovial joint is surrounded by a synovial membrane. During synovitis, this membrane gets inflamed, and synovial fluid collects inside the membrane. The inflammation and swelling cause pain during joint movement.

Bursitis

Polymyalgia Rheumatica often causes bursitis in the shoulder, hip, and neck joints. Bursitis is the inflammation of a bursa. A regular bursa is a tiny fluid-filled sac that functions to reduce friction and ensure smooth movement between the bone and the surrounding tissues, such as muscles, ligaments, tendons, and other soft tissues adjacent to the bone. Normally, the bursa is lined by a synovial membrane and contains a small amount of fluid. In bursitis, the membrane of the sac is inflamed, and there is fluid buildup inside the sac, causing further pain.

Tenosynovitis

Tendon sheaths are the outer covering of tendons and are also made of synovial membrane tissue, which is prone to inflammation in Polymyalgia Rheumatica. This inflammation of the synovial membrane of tendon sheaths is known as tenosynovitis.

The exact cause of inflammation of the synovial membrane tissue in Polymyalgia Rheumatica remains unknown. Some studies suggest that environmental factors and genetics play a role in the course of joint inflammation in Polymyalgia Rheumatica.

Recommended Treatment & Rehabilitation

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During a diagnosis of PMR, your doctor will begin by gently moving your head and limbs to assess your range of motion. A physical examination and medical history can be useful in identifying the signs of Polymyalgia Rheumatica. The most common findings may include:

 

  • Severe pain and / or swelling in both shoulders are seen.
  • Pain in the neck and hip.
  • Tenderness in the hip, shoulder, and upper arm.
  • Fever.

 

Your doctor may recommend the following tests after your physical exam:

 

  • Blood tests – Besides checking your complete blood counts, your doctor will look for two indicators of inflammation (erythrocyte sedimentation rate and C-reactive protein).
  • Ultrasound – Ultrasound imaging of the shoulders and hips can identify bursitis, synovitis, and tenosynovitis in the affected areas. Inflammation in Polymyalgia Rheumatica can result in subdeltoid bursitis, trochanteric bursitis, biceps tenosynovitis, and glenohumeral synovitis.

 

The treatment of Polymyalgia Rheumatica is aimed at reducing pain and managing symptoms. Here are some treatments that can help improve symptoms linked to PMR:

 

Corticosteroids

Polymyalgia Rheumatica is typically treated with a low dose of an oral corticosteroid, such as prednisone. You might begin to feel relief from pain and stiffness within the first two or three days. After the first 2 to 3 weeks of treatment, your doctor might begin to gradually decrease your dosage depending on your symptoms and the results of blood tests. Because of the potential side effects, the ultimate goal is to keep you on an as low dose as possible without triggering a relapse in your symptoms. Generally, most patients with PMR need to continue the corticosteroid treatment for a year or more. However, long-term use of corticosteroids can result in serious side effects, including weight gain, loss of bone density, high blood pressure, diabetes, and cataracts.

Methotrexate

Doctors may suggest using methotrexate with corticosteroids in some patients. This is an immune-suppressing medication that is taken by mouth. It may be useful early in the course of treatment or later if you relapse or don’t respond to corticosteroids.

Glucocorticoids

The most commonly prescribed drug for Polymyalgia Rheumatica is a type of steroid called Glucocorticoid. Glucocorticoid medications reduce inflammation and in turn relieve pain.

Most patients who take corticosteroids for PMR return to their regular levels of activity. However, if you have been dealing with limited activities for a long period of time, physiotherapy might be beneficial. Treatment plans including range of motion exercises for the shoulders can help reduce pain and maintain mobility.

In addition, using certain devices can help simplify your daily activities so you can avoid strenuous joint movement. Here are a few ways you can try to simplify your regular daily activities:

 

  • Walker – Using a walker may help you get out of bed and walk around easily when your hips are painful and stiff due to Polymyalgia Rheumatica.
  • Handle bath brush and hairbrush – These are available to help you avoid repeated bending, raising, and moving arms.
  • Rolling laundry cart – to carry clothes to and from the laundry room, so you can avoid lifting heavy laundry baskets. If a laundry cart isn’t helpful enough, try using a smaller laundry basket and making multiple trips or doing smaller loads.
  • Grabber tool – A grabber tool may help you reach the top of your highest kitchen cabinet shelf, grab clothes from the dryer, or even serve as a dressing aid.

These supportive devices mentioned above can help you limit your range of motion when you feel pain and stiffness from Polymyalgia Rheumatica.

Alternative & Homeopathic Treatment

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Fortunately, there are a wide variety of homeopathic treatments that can all help you improve symptoms associated with Polymyalgia Rheumatica without the need for the use of steroids. The following alternative treatments include:

 

  • Calcium and Vitamin D supplements – Since some medications for PMR increase osteoporosis risks, foods that are high in calcium and vitamin D can be helpful. Therefore, to reduce the risk of bone damage, calcium and vitamin D supplements are commonly prescribed during PMR treatment.
  • Meditation and relaxation – These techniques can improve concentration, release feel-good hormones (endorphins), and decrease anxiety and stress. Adding essential oils such as lavender oils can help boost your recovery process while relaxing.
  • Yoga and tai chi – Performing yoga or tai chi sessions can provide flexibility to help improve PMR joint and muscle symptoms. It is important to perform stretches slowly and advance only if you feel comfortable without pain.
  • Staying hydrated – Making sure that you’re well-hydrated can help fight inflammation due to Polymyalgia Rheumatica. The recommended daily intake for adults is 2-3 liters of fluid per day.
  • Coffee – Coffee is known to contain some anti-inflammatory effects. Studies have shown that the inflammatory impact on each person varies when it comes to coffee drinking.