All you need to know about Polymyalgia Rheumatica.
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A relatively common chronic inflammatory disorder of unknown etiology that affects elderly people is Polymyalgia rheumatica (PMR). It is characterized by proximal myalgia with associated morning stiffness of the hip and shoulder girdles that lasts more than 1 hour. Around 15 percent of PMR patients experience giant cell arteritis (GCA), and 40–50 percent of GCA patients have PMR associated with it. The relationship between GCA and PMR is not yet clearly known, despite the similarities between age at initiation and some of the clinical manifestations.
PMR is a clinical diagnosis focused on the intensity of the symptoms presented and the exclusion of all suspected diseases (see Presentation and Work-up). The medication of choice is known to be corticosteroids, and a fast reaction to low-dose corticosteroids is known pathognomonic. The addition of methotrexate or tocilizumab can be effective in patients who are at risk of relapse, have steroid-related adverse effects, or require extended steroid therapy.
Patients have an exceptional prognosis. However, exacerbations can occur if steroids are tapered too fast, and relapse is prevalent.
Who gets the disease:
Women are more likely than males to develop rheumatic polymyalgia. This disease primarily affects individuals over the age of 50, with the highest prevalence being between the ages of 70 and 80.
The estimated annual occurrence of polymyalgia rheumatica (PMR) in the United States is 52.5 cases per 100,000 individuals aged 50 years and older. The prevalence is roughly 0.5–0.7 percent. The average age-and sex-adjusted annual incidence of PMR was 63.9 per 100,000 population aged around 50 years in a Mayo Clinic study from 2000–2014; the incidence rate in those years was marginally higher compared to 1970–1999.
Worldwide, by region, the frequency varies. In Europe, with a high incidence in Scandinavia and a low incidence in Mediterranean countries, the occurrence decreases from north to south. The incidence in Italy, for example, is 12.7 cases per 100,000 people. An overall incidence rate of 95.9 cases per 100,000 population was found in a United Kingdom study. The prevalence of PMR in patients aged 55 years and older ranged from 0.91 percent to 1.53 percent in a comprehensive analysis of case reports from a major primary care practise in the UK, depending on the criteria set for diagnosis.
Rather than other ethnic groups, whites are impacted. PMR in blacks is recorded only occasionally. In women, PMR is twice as popular.
With advanced age, the occurrence rises. PMR seldom affects individuals younger than 50 years of age. The median age is 72 years at diagnosis.
The most common symptoms of Polymyalgia rheumatica are discomfort and stiffness in the neck and shoulders. In other areas, such as the shoulders, hips, and thighs, the pain and stiffness can gradually spread. Typically, these symptoms affect all sides of the body.
Other common symptoms of polymyalgia rheumatica include: fatigue, malaise, a loss of appetite, sudden, unintentional weight loss, anemia, or low red blood cell count, depression, a low-grade fever, a limited range of motion.
Polymyalgia rheumatica symptoms progress gradually, generally over many days. The symptoms may occur overnight in some cases. They seem to be weaker throughout the morning and change during the day steadily. Being inactive and sitting in one place for a long period of time will make symptoms worse for certain individuals.
Ultimately, the discomfort and stiffness can become so serious that individuals have trouble performing regular tasks, such as standing up from the sofa, getting dressed, or getting into a car. Sometimes, the symptoms of rheumatic polymyalgia can also make falling asleep difficult.
The cause of rheumatic polymyalgia is not understood. It is, however, believed that certain genes and variations in genes can increase your risk of developing rheumatic polymyalgia. Environmental factors can also play a role in the disorder‘s growth. New cases of rheumatic polymyalgia are often diagnosed in cycles that typically take place seasonally. This indicates that there could be an environmental trigger that triggers the disease, such as a viral infection. The sudden development of symptoms also indicates that an infection may be the cause of polymyalgia rheumatica. No such relation has been found, however.
Risk factors for polymyalgia rheumatica include:
- Age. Polymyalgia rheumatica affects older adults almost exclusively. It most often occurs between ages 70 and 80.
- Sex. Women are about two to three times more likely to develop the disorder.
- Race. Polymyalgia rheumatica is most common among white people whose ancestors were from Scandinavia or northern Europe.
Symptoms of polymyalgia rheumatica can greatly affect your ability to perform everyday activities, such as:
- Getting out of bed, standing up from a chair or getting out of a car
- Combing your hair or bathing
- Getting dressed
These difficulties can affect your health, social interactions, physical activity, sleep and general well-being.
- The symptoms of polymyalgia rheumatica, including lupus and arthritis, can be similar to those of other inflammatory conditions. Your doctor will conduct a physical exam to make an accurate diagnosis and run multiple tests to check for inflammation and blood irregularities.
- Your doctor can gently shift your neck, arms , and legs during the exam to assess your range of motion. If there is a suspicion of polymyalgia rheumatica, they may order blood tests to check the body for signs of inflammation. Your erythrocyte sedimentation rate and C-reactive protein levels will be calculated by these tests. Inflammation is typically demonstrated by an abnormally high sedimentation rate and elevated C-reactive protein levels.
- To check for inflammation in your joints and tissues, your doctor can also schedule an ultrasound. Using high-frequency sound waves, ultrasound creates accurate pictures of the soft tissue in various parts of the body. This can be very useful in differentiating rheumatic polymyalgia from other disorders that cause similar symptoms.
- Your doctor may want to conduct a biopsy because there is a link between polymyalgia rheumatica and temporal arteritis. This biopsy requires the removal of a small sample of tissue from an artery in your temple and is a simple , low-risk procedure. The sample is sent to a laboratory and the symptoms of inflammation are examined. You just need to get a biopsy if your doctor suspects inflammation of the blood vessels.
Monitoring for giant cell arteritis:
- New, unusual or persistent headaches
- Jaw pain or tenderness
- Blurred or double vision or visual loss
- Scalp tenderness
There’s no treatment for rheumatic polymyalgia. However, with the right care, symptoms will improve within as little as 24 to 48 hours. To help relieve inflammation, the doctor will prescribe a low-dose corticosteroid, such as prednisone. Typical dosages are between 10 and 30 milligrammes a day. Medicines for over-the-counter pain, such as ibuprofen and naproxen, are not effective in treating the symptoms of rheumatic polymyalgia.
- Corticosteroids Like Prednisone:
You start with a low daily dose, which is increased until the symptoms disappear, as needed. Your doctor may then decrease the dose steadily, and after six months to two years, you will possibly stop taking the drug. If symptoms reappear with lower doses of the drug, the doctor will place you back on the corticosteroid. When the symptoms fully clear up, you will stop taking the medication.
- Nonsteroidal anti-inflammatory drugs (NSAIDs):
Such as ibuprofen and aspirin. The drug must be taken regularly, and stomach pain may be caused by long-term use. NSAIDs alone are not enough for most patients to ease symptoms.
- Vitamin D and calcium: As a result of corticosteroid therapy, the doctor will typically recommend regular doses of calcium and vitamin D supplements to help avoid bone loss. For any person taking corticosteroids for three months or longer, the American College of Rheumatology recommends 1,000 to 1,200 milligrams of calcium supplements and 600 to 800 foreign units of vitamin D supplements.
- Physical Therapy:
Most individuals who take rheumatic polymyalgia corticosteroids return to their previous levels of activity. However, you could benefit from physical therapy if you’ve had a long period of little exercise. Speak to your doctor about whether a suitable choice for you is physical therapy.
Also without medication, within one to several years, polymyalgia rheumatica typically disappears. However, with medication, symptoms vanish rapidly , usually within 24 to 48 hours. If corticosteroids don’t help, it is likely that the doctor will suggest other potential diagnoses.
How to cope up:
Healthy lifestyle choices can help you manage the side effects that corticosteroid treatment can cause:
- Eat a healthy diet. Eat a diet of fruits, vegetables, whole grains, and low-fat protein and dairy products. Limit the salt (sodium) in your diet to prevent fluid buildup and high blood pressure.
- Exercise regularly. Talk to your doctor about exercise that’s appropriate for you to maintain a healthy weight and to strengthen bones and muscles.
- Get enough rest. Rest is necessary for your body to recover from exercise and activities of daily living.
- Use assistive devices. Consider using luggage and grocery carts, reaching aids, shower grab bars, and other assistive devices to help make daily tasks easier.
Gopala Krishna Varshith,
Content Developer & Editor,