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Polymyalgia Rheumatica a rare inflammatory disease

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  • gladys5last
    Polymyalgia Rheumatica What is Polymyalgia Rheumatica? Polymyalgia Rheumatica (PMR) is a rare inflammatory disease that causes stiffness (myalgia), and pain in
    Message 1 of 2 , Jul 9, 2006
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      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
      or thighs
      „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
      „h Depression

      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
      double.
      „h Pain in the jaw, often while chewing food
      „h Dizziness.
      „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
      immediately.
      Diagnosis
      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.



      Etiology
      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
      States
      „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.

      Treatment
      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
      needed.

      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.

      Self-care
      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
      tasks easier.

      Prognosis
      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.

      Investigational Therapies
      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.


      Bibliography

      Articles
      1. National Organization for Rare Disorders,Inc (NORD), Danbury, CT.,
      2002

      Internet
      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
      5/2/05

      Brochure:
      Sound Concepts, (Research Publications, LLC), Orem, Utah, 2003, ¡§An
      introduction to Xanthones¡¨.

      No books on this subject available in the library





      History patient:
      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.
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