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Treatment For

Polymyalgia Rheumatica

Polymyalgia Rheumatica usually referred to as PMR is an inflammatory disorder that causes sudden muscle pain and stiffness, especially in the shoulders and hips. Symptoms often occur quickly and are typically more severe in the morning.

Who Develops Polymyalgia Rheumatica?

Most people who do develop Polymyalgia Rheumatica are older than 65. It rarely affects people under the age of 50 years old.

There’s no specific test or labs to diagnose polymyalgia rheumatica.

The diagnosis is based on your symptoms or history, physical exam and elevated inflammation tests. Your doctor will also screen you for other causes of autoimmune disease that may have similar symptoms, including rheumatoid arthritis.

Causes

The exact cause of Polymyalgia Rheumatica is currently unknown. Two factors are currently believed to be involved in the development of this condition:

  • Genetics. Certain genes and gene variations may increase your chances of getting Polymyalgia Rheumatica
  • Environmental exposure. New cases of Polymyalgia Rheumatica tend to come in cycles, possibly developing seasonally. This suggests that a trigger in your environment, such as a virus, might be a cause. However, no specific virus has been shown or proven to cause Polymyalgia Rheumatica. Currently there are no preventative measures one can take to avoid getting PMR, it just happens.

Symptoms

The signs and symptoms of Polymyalgia Rheumatica most often occur on both sides of the body and frequently include:

 

  • Aches or pain in your shoulders
  • Aches or pain in your neck, upper arms, buttocks, hips, or thighs
  • Hours of stiffness in the morning that improves throughout the day and returns in the evening.
  • Limited range of motion in the shoulders and difficulty standing from a chair.

You might also have more-general signs and symptoms, including:

 

  • Fatigue
  • A general feeling of not being well (malaise)
  • Loss of appetite
  • Unintended weight loss
  • Depression

Treatments

We follow recommended guidelines in treatment and care of individuals with Polymyalgia Rheumatica. However, each person is different and therefore we individualize care for each of our patients depending on their personal circumstances. Each person is different and some respond differently to treatment.

If you have this condition, you should have a treatment plan tailored to you, that includes:

  • Initial dose of steroids with a plan to taper the steroid dose over time will get each patient off the steroid in the quickest time possible, but not so fast that PMR returns. The majority of patients will need approximately 1 year of tapering steroids to fully treat this condition if they are being managed closely by a rheumatologist.
  • Monitoring of Osteoporosis and treatment to help prevent developing Osteoporosis.
  • Access to education focusing on the impact of the condition.

Living With Polymyalgia Rheumatica

Steroid medications, most often prednisone, are very effective at treating Polymyalgia Rheumatica.

Steroids work by reducing inflammation. Symptoms will often improve within 48 hours of starting treatment, and patients often return to normal within approximately two weeks.

Potential side effects can include weight gain and the development of osteoporosis, which causes people’s bones to become fragile and weak, predisposing them to fragility fractures more easily. Your doctor will often screen you for Osteoporosis at the time of diagnosis and start medication to help prevent Osteoporosis if needed during your treatment of PMR.

There are groups of people who could be at an increased risk of side effects, including those who have:

  • Diabetes
  • High blood pressure
  • A recent fracture
  • A peptic ulcer
  • A cataract glaucoma.

Even if you are feeling well, your doctor will plan to see you regularly to monitor for side effects of the medication. Frequent monitoring also helps to get you off the steroid as quickly as possible without a return of symptoms, thus reducing the risk of long-term side effects of these drugs.

You should notify your other providers that you are being treated for this condition and are on steroids. One of the biggest issues that affect patients and providers today is treating this condition if you also have diabetes, as steroids can greatly raise blood sugar. Patients must also work closely with their primary care doctor during this time if they have diabetes to keep their blood sugars under control.