What is Polymyalgia Rheumatica?
Polymyalgia rheumatica is an inflammatory medical condition which is characterized by muscle stiffness and pain, particularly in the shoulders. Patient experiences symptoms of polymyalgia rheumatica suddenly or abruptly and they are at their worse in the morning. Individuals aged above 60 are more often affected by this condition. Corticosteroids provide symptom relief. However, polymyalgia rheumatica patients can often experience relapses and needs regular visits to the doctor to monitor for any side effects of these medicines.
Polymyalgia rheumatica is associated with giant cell arteritis, which is another inflammatory disorder characterized by headaches, jaw pain, vision problems and tenderness in the scalp. Sometimes, patient can also have both of these conditions together.
Causes of Polymyalgia Rheumatica
The exact cause of polymyalgia rheumatica is not clear. However, there are two aspects which seem to be associated with development of polymyalgia rheumatica and these are:
- Genetics seem to play a role in the development of polymyalgia rheumatica. There are some genes and certain alterations in genes that increase the risk for developing this condition.
- Environmental exposure is also thought to play a role in polymyalgia rheumatica. According to studies, some patients develop polymyalgia rheumatica in cycles or develop it seasonally. This indicates that there can be an environmental trigger to it, such as a virus. However, till now there is no proof of any specific virus causing polymyalgia rheumatica.
Risk Factors of Polymyalgia Rheumatica
- Individuals over the age of 70 are at an increased risk for developing Polymyalgia Rheumatica.
- Whites in Northern European populations are at a higher risk for developing Polymyalgia Rheumatica.
- Women are twice at risk for developing Polymyalgia Rheumatica than men.
Signs & Symptoms of Polymyalgia Rheumatica
- The initial symptom of Polymyalgia rheumatica is often pain or aches in the shoulders.
- Pain or aches in the upper arms, neck, buttocks, thighs or hips.
- Polymyalgia rheumatica patient experiences symptoms of stiffness or pain in the wrists, elbows or knees.
- Stiffness in affected areas, particularly in the morning or after being inactive for a long time
- Polymyalgia rheumatica patients have symptoms of restricted range of motion in the affected regions.
- Patient may have mild fever.
- Patient has loss of appetite.
- There is unintentional weight loss.
- Patient suffering from polymyalgia rheumatica feels fatigued and malaise, which is a general feeling of being unwell.
- Patient can suffer from depression also.
Polymyalgia rheumatica patient should immediately contact their physician if they develop sudden and new pain, aches or stiffness that disrupts the sleep and restricts activities of daily living, such as combing or getting dressed.
Complications of Polymyalgia Rheumatica
Polymyalgia rheumatica greatly affects the patient's quality of life, as it greatly hinders the patient's ability to perform daily activities of living. Due to the muscle stiffness and pain, patient finds it difficult to get out of bed, getting out of a car, bathing, getting up from a chair, combing, and getting dressed. All these things have a vast negative impact on the patient's mental health, physical activity, sleep, social interactions and overall well-being. Other than this, patients with polymyalgia rheumatica seem more prone to developing peripheral arterial diseases.
Diagnosis of Polymyalgia Rheumatica
- Physical exam and medical history of the patient helps in determining the cause of stiffness and pain. The doctor will also exclude other disorders, which exhibit symptoms similar to polymyalgia rheumatica. The diagnosis of polymyalgia rheumatica is reassessed as the treatment goes on, as some patients who were initially diagnosed as having polymyalgia rheumatica, later were re-diagnosed as having rheumatoid arthritis.
- The doctor also gently moves the patient's head and limbs to assess patient's range of motion and to see if it is affected by the symptoms of polymyalgia rheumatica.
Blood tests, such as complete blood count (CBC) are done. Other blood tests which are an indicator of inflammation such as C-reactive protein and ESR (erythrocyte sedimentation rate) are also done.
- Imaging tests, such as ultrasound helps in differentiating polymyalgia rheumatica from other disorders which produce similar symptoms. Magnetic resonance imaging (MRI) scan helps in identifying other causes of pain in the shoulders, such as degenerative joint disease.
Polymyalgia Rheumatica & Giant Cell Arteritis
Polymyalgia rheumatica is similar to giant cell arteritis in many ways. Giant cell arteritis is a condition characterized by inflammation in the arterial lining causing jaw pain, headaches, scalp tenderness and vision problems. If this condition is ignored, then patient can end with blindness or stroke.
It is also thought that Polymyalgia rheumatica and giant cell arteritis may be the same condition, however, with different manifestations. There is significant overlap between these two conditions such as:
- About 50% of patients with giant cell arteritis may also suffer from polymyalgia rheumatica.
- Around 20% of patients suffering from polymyalgia rheumatica also exhibit signs and symptoms of giant cell arteritis.
Monitoring for Giant Cell Arteritis
The patient is monitored for signs and symptoms, which indicate the start of giant cell arteritis. Medical attention should be immediately sought if the patient is having sudden, new and constant headaches, tenderness or pain in the jaw, vision problems or scalp tenderness. If giant cell arteritis is suspected, then biopsy may be done of the artery present in the temples and the sample taken is sent to laboratory to look for signs of inflammation.
Treatment for Polymyalgia Rheumatica
Treatment of Polymyalgia Rheumatica consists of medications for symptom relief and to prevent relapses, which are common.
- Corticosteroids are the medications which are commonly given for treating the symptoms of Polymyalgia Rheumatica. Patient is initially started on a low dose oral corticosteroid, such as prednisone for relief from stiffness and pain. If this treatment is not effective, then the patient may be referred to a rheumatologist.
- After a couple of weeks to a month of Polymyalgia rheumatica treatment, the dosage of the corticosteroid is gradually decreased depending on the results of blood tests and patient's symptoms. The aim of treatment for polymyalgia rheumatica is to maintain the patient on the lowest dose as possible without setting off a relapse of the symptoms.
- Most of the polymyalgia rheumatica patients need treatment with corticosteroids for at least a year. Patient needs to follow up with their doctor regularly to monitor the effect of treatment and the side effects of the medication if any.
- If the Polymyalgia rheumatica patient is tapered off the medication rapidly, then the chances of a relapse are more. About half of the patients suffering from polymyalgia rheumatica will suffer from a minimum of one relapse while tapering off the corticosteroids. Flare ups or relapses of Polymyalgia rheumatica are then treated by increasing the dosage of the medicine and then tapering it again.
- Patient needs to be monitored closely for side effects as long-term use of steroids can cause serious side effects. The doctor will adjust the dosage accordingly and prescribe treatment for the side effects to corticosteroid treatment. Some of the side effects include: weight gain, osteoporosis, hypertension, cataracts and diabetes.
- Calcium and vitamin D supplements are prescribed to prevent bone loss in polymyalgia rheumatic patients, which can occur as a side effect of corticosteroid treatment.
- The patient is also advised to take pneumonia vaccine if taking prednisone 20 mg or more daily.
- Methotrexate can also be prescribed along with corticosteroids, as it can be beneficial in early stages of treatment or if the patient has a relapse or doesn't respond to corticosteroids.
- Physical Therapy helps in regaining strength, flexibility and coordination, which helps the patient in performing daily tasks with lesser difficulty.
Lifestyle Modifications for Polymyalgia Rheumatica
Making healthy lifestyle modifications helps the patient in managing the side effects of the treatment and symptoms of Polymyalgia Rheumatica:
- It is important to follow a healthy diet comprising of vegetables, fruits, low-fat meat, whole grains, and low-fat dairy products. It is important to restrict the salt in diet, as it leads to fluid accumulation and high blood pressure.
- It is important to incorporate some type of exercise daily to maintain healthy weight, and to strengthen muscles and bones.
- Assistive devices can be used, such as grocery and luggage carts, shower grab bars, reaching aids, cane and wearing low-heeled shoes to help make daily tasks easier.