Polymyalgia Rheumatica a rare inflammatory disease
- Polymyalgia Rheumatica
What is Polymyalgia Rheumatica?
Polymyalgia Rheumatica (PMR) is a rare inflammatory disease that
causes stiffness (myalgia), and pain in the neck, shoulders, upper
arms, thighs and hips. The lower arms, hands, lower legs, and feet
are not usually affected by this disorder. Stiffness and pain are
most severe in the morning and after long periods of rest or
inactivity. Without treatment the stiffness and pain can get worse
over time. Additional generalized systemic symptoms such as fatigue,
low grade fever, and/or general feeling of ill health (malaise) may
appear. Although some people develop these symptoms gradually, PMR
can literally appear overnight.
Polymyalgia Rheumatica is a relatively benign condition that is
extremely responsive to treatment. In some rare cases permanent
muscle weakness, degeneration and loss (atrophy) of muscle mass, and
disability may occur. The exact cause of PMR is unknown, although
immunological factors and familial tendencies (genetic
predisposition) have been mentioned in the medical literature.
Polymyalgia rheumatica is closely related to giant cell arteritis,
another inflammatory disorder. Giant cell arteritis is characterized
by progressive inflammation of many arteries in the body. These two
disorders have been described in the medical literature as possible
variants of the same disease process. Some researchers believe they
represent different ends of a disease continuum. The exact nature of
the association is not fully understood.
Signs and Symptoms
The warning signs of polymyalgia rheumatica include:
h Severe pain and stiffness in the neck, shoulders, lower back, hips
h Low energy and fatigue
h Profuse sweating during sleep. This is called night sweats
h Loss of appetite
h Slight fever
h Anemia. This is a condition of the blood that can cause a person to
look pale, and feel weak, sleepy and dizzy
The warning signs of giant cell arteritis include:
h Tenderness of skin on the forehead
h Redness and swelling of the blood vessels on the side of the head.
These may be painful to press on
h Changes in vision such as blurred vision, blind spots or seeing
h Pain in the jaw, often while chewing food
h Problems with hearing
h Sore throat and coughing
As mentioned before, If you have PMR you will probably experience
muscle pain and stiffness in specific parts of your body, usually the
neck, shoulder, lower back, hips and/or thighs. However, there are a
variety of other symptoms that may indicate the presence of PMR. The
danger of giant cell arteritis is that it can cause blindness.
Therefore, if you have already been diagnosed with PMR and develop
any of the giant cell arteritis symptoms, contact your doctor
If your doctor diagnoses you with PMR, he/she may refer you to a
Rheumatologist who is specialized in the diagnosis and treatment of
problems with muscles, joints and bones. The signs and symptoms of
PMR are similar to those of a number of other conditions, including
Rheumatoid Arthritis and Polymyosis. For that reason, your doctor
will diagnose PMR only after ruling out other possible causes for
your pain and stiffness.
To aid in the diagnosis, your doctor will take your medical history,
current symptoms, and a thorough physical exam. Additionally, your
doctor will order some laboratory tests, including:
h Sed rate. If you have PMR you will have an elevated erythrocyte
sedimentation rate (ESR). This test measures how quickly your red
blood cells settle when placed in a test tube. Generally, the blood
cells fall faster ¡V that is the sed rate increases ¡V when
inflammation is present. An elevated sed rate alone can¡¦t confirm the
presence of PMR, there are other conditions that can cause
inflammation in your body, like infections, chronic diseases, such as
arthritis and other rheumatic disorders.
h EMG. This test measures the electric current in your muscles.
Electrodes are taped to your skin and the the electric currents
running through your muscles are recorded.
h Rheumatoid factor (RF) is an antibody ¡V a protein made by the
immune system ¡V that is often present in the blood of people with
rheumatoid arthritis, but not in the blood of people with PMR. This
test can help your doctor distinguish between the two conditions.
h Other blood tests. Checking the number of red blood cells and
platelets (thrombocytes) in your blood. Platelets are colorless blood
cells that help stop blood loss when you are injured. Most people
with PMR have an unusually high number of these cells
(thrombocytosis). On the other hand, many people with PMR have a
lower number of red blood cells than normal and are often anemic.
h There is also a simple and inexpensive blood test that can be done
by checking the levels of C-reactive protein in your blood. The
protein is produced by the the liver as part of a normal immune
system response to injury or infection. High blood levels of C-
reactive protein may indicate the presence of inflammation.
If you receive a diagnosis of PMR, your doctor will also check you
for giant cell arteritis, which occurs in 15% of people with PMR.
Signs and symptoms such as new headaches, a tender scalp and pain
when you chew, along with the results of a sed rate can help
determine whether you have this disorder. The only way to confirm
this disorder is by taking a biopsy from the scalp artery in your
temple. The sample is then examined under a microscope in a
laboratory. PMR and giant cell arteritis are both treated with
corticosteroids, so in most cases it is suggested to begin treatment,
rather than perform a biopsy.
Polymyalgia Rheumatica is an arthritic syndrome that causes your
muscles to feel achy and stiff due to mild inflammation in your
joints and surrounding tissues. As mentioned before, most of the
inflammation occurs in the hip and shoulder joints, but it may
develop elsewhere in the body as well. In general, the inflammation
isn¡¦t as severe as that in inflammatory types of arthritis, such as
rheumatoid arthritis. In PMR, inflammation occurs when white blood
cells ¡V which normally protect your body from invading viruses and
bacteria ¡V attack the lining of your joints (synovium). Researchers
aren¡¦t sure what causes this abnormal immune system response, but
they suspect that as with many disorders, both genetic and
environmental factors are involved. There maybe a link between PMR
and certain viruses, such as adenovirus, which causes respiratory
infections ranging from the common cold to pneumonia; human
parvovirus B19, the source of an infection that primarily affects
children; and human parainfluenza virus.
Although the exact causes of PMR are unknown, certain factors may
increase your risk of developing the disease, including:
X Age. PMR affects older adults almost exclusively . Rarely does it
affect people under 50 years old. The average age is 70. Polymyalgia
Rheumatica is estimated to affect 450,000 individuals in the United
X Sex. Women are afflicted twice as often as men.
X Race. Although PMR can affect people of any race, the vast majority
are white. People of Northern European and Scandinavian origin are
particularly at risk.
X Giant cell arteritis. Also at risk are people with giant cell
arteritis. As many as half of people with giant cell arteritis also
have polymyalgia rheumatitis.
The conventional way to treat PMR are nonsteroidal anti-inflammatory
drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin, others)
for mild symptoms of PMR. Long-term use can cause stomach and
intestinal bleeding, fluid retention, high blood pressure, renal
insufficiency, worsening congestive heart failure, liver function
test abnormalities, and possible cognitive changes.
For more severe cases of PMR a low, daily dose of an oral
corticosteroid drug such as prednisone is the usual treatment. Relief
should be almost immediate. In fact, your response to the prednisone
is one way your doctor may confirm the diagnosis. The dose of
prednisone needed at first is 10 to 20 mg per day. Rarely more is
Side effects of corticosteroids (Prednisone)
Cortisone is a steroid that reduces inflammation and swelling. It is
a hormone naturally produced by the body. Corticosteroids are man-
made drugs that closely resemble cortisone. The most common form of
corticosteroid is called prednisone, taken in pill form. Prednisone
use needs to be carefully monitored, and the drug must never be
stopped abruptly. Some of the side effects from long-term use include
cataracts, high blood pressure, sleep problems, muscle loss,
bruising, thinning of the bones (osteoporosis), weight gain and
increased risk of infections. For treatment of PMR the dose is
rapidly decreased to the lowest doses possible. The goal with this
drug (most drugs) is to find the lowest effective dose that will
avoid as many of the side effects as possible.
Exercise may help reduce pain and will prevent muscles from becoming
weak. Emphasize low-impact exercises such as swimming, walking, and
riding a stationary bicycle. Moderate stretching is also important to
keep your muscles and joints flexible.
Diet. Eating a healthy diet can help prevent potential problems such
as thinning bones, high blood pressure and diabetes. Good nutrition
can also support your immune system. Emphasize fresh fruits and
vegetables, whole grains, and lean meats and fish, while limiting
salt, sugar, and alcohol.
Supplements. Get adequate amounts of bone-building nutrients ¡V
calcium and vitamin D. If you find it hard to get calcium from your
diet, try calcium supplements
Relaxation. There are many ways to relax. Try deep breathing
exercises, listen to music or relaxation tapes. Meditation or
praying. Visualize a pleasant activity, such as lying on the beach,
or sitting in front of a fireplace.
Heat/Cold. Applying heat helps relax aching muscles, and reduces pain
and soreness. For example, take a hot shower. Applying cold helps to
lessen the pain and swelling. For example, put an ice pack on the
area that is sore.
Heat or cold application can give temporary relief of pain.
Last but not least:
Pace yourself. Try to alternate strenuous or repetitive tasks with
easier ones to prevent straining painful muscles. Use luggage and
grocery carts, reaching aid, and shower grab bars to help make daily
Polymyalgia Rheumatica usually goes away of its own account, but it
is impossible to predict how long the disease will last in any
person. Once the pain and stiffness of PMR lessen, all patients are
encouraged to resume their normal activities, trying to strike a
balance between too much and too little activity.
Giant cell arteritis appears to run its course over a three to five
year period with severe pain gradually disappearing. There is also
the possibility of loss of vision. However, with treatment, pain
subsides and vision loss is rare.
The corticosteroid drug deflazacort is being studied for treatment of
PMR. Deflazacort may be an effective alternative to prednisone and
may also have fewer side effects. More studies are needed to
determine the long-term safety and effectiveness of this drug for the
treatment of PMR.
Researchers are studying the effects of immunosuppressants such as
methotrexate in the treatment of individuals with PMR. Clinical
trials are needed to determine the long-term safety and effectiveness
of this potential treatment for PMR.
1. National Organization for Rare Disorders,Inc (NORD), Danbury, CT.,
2. Mayo Clinic Health Information, by Mayo Clinic Staff, May 17, 2006
3. The Gale Encyclopedia of Medicine, ¡§Polymyalgia rheumatica¡¨ by J.
Ricker Polsdorfer, MD, 2001
4. American Academy of Family Physicians, ¡§Polymyalgia rheumatica and
Temporal Arteritis¡¨, August 15, 2000, updated 12/05
5. The Arthritis Society, ¡§Polymyalgia rheumatica¡¨, 2002, updated on
Sound Concepts, (Research Publications, LLC), Orem, Utah, 2003, ¡§An
introduction to Xanthones¡¨.
No books on this subject available in the library
I was not able to find alternative treatments for Polymyalgia
Rheumatica on websites, articles, and books. My neighbor-friend (78
years old) suffers from PMR and asked me for an alternative
treatment. She has been taking prednisone for over a year and gained
20 lbs. She also suffers from macular degeneration and is afraid that
it will affect her vision as well. The dose of prednisone is down to
5 mg a day for the last 3 months. I talked to her June 24, and she
told me she had stopped taking prednisone and instead she takes
Tylenol as needed. She said she is doing fine right now. My concern
is that her symptoms will come back by stopping her medication
abruptly. With PMR symptoms can disappear for periods of time
(remission) and then reappear (exarbation). She always takes her
vitamins and minerals religiously. I suggested to add fish oil
capsules and Mangosteen juice to her routine.
Dr. Mercola(website) recommended to take more anti-oxidants if you
take fish oil capsules, so taking Mangosteen juice also would be a
good choice because it is a strong anti-oxidant. Mangosteen juice is
beneficial for many health challenges and equals or out performs
prescription drugs, amongst others Prednisone and over-the-counter
drugs. The anti-inflammatory activities of natural xanthones found in
the mangosteen plant are significant. Xanthone compounds have so far
been found to exhibit the following beneficial activities and
actions: anti-inflammatory, anti-oxidant, anti-microbial, anti-
fungal, anti-viral, anti-cancer, anti-tumor, anti-ulcer, anti-
hepatotoxic, anti-rhinoviral, anti-allergic.
Hopefully, it will help my neighbor¡¦s condition.