Know the signs of polymalgia rheumatica

The symptoms tend to develop quickly, during a period of a few days or a week, and occasionally overnight. Difficulty raising the upper arms above the shoulders is common. Aching and stiffness are worse in the morning, and tend to improve gradually as the day progresses. Occasionally this aching occurs in joints such as those of the hand and feet.

Causes unknown

The cause is unknown. “Myalgia” is a term for “muscle pain,” but tests for muscle damage are not elevated. We now know PMR is an arthritis that has a tendency to involve the shoulder and hip joints and the bursae around these joints. The pain in the arms and thighs comes from the nearby shoulder and hip joints.
Who gets PMR?

It occurs in older adults, and rarely in people younger than 50. Average age is older than 60. Women are affected somewhat more than men, and the disease is more frequent for caucasians.

PMR is not unusual — it is diagnosed more frequently than Rheumatoid arthritis in older adults.

Diagnosis and treatment

Blood tests that detect inflammation are helpful. These include ESR (sedimentation rate) and C-reactive protein tests. Both tests are elevated in most patients, but a small portion of patients can have these tests normally.

When a physician strongly suspects PMR, a trial of Prednisone is given daily. If patients have PMR, they have a response in a matter of few days — and the response is dramatic.  Ibuprofen, naproxen and Tylenol are minimally helpful at best.

The Prednisone dose is gradually reduced during a period of 12 months to 18 months. The goal is to find the lowest helpful dose that keeps the patient comfortable. Clinicians monitor lab results on a regular basis while tapering the Prednisone. Also, side effects of chronic Prednisone therapy are monitored, such as increasing blood sugar, weight gain and osteoporosis. View the complete article
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