What Is Polymyalgia Rheumatica (PMR)?
Polymyalgia rheumatica is a condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips. The condition known as PMR most commonly starts after the age of 60, though it can start as early as 50, and it affects women more often than men. The causes are unknown but a combination of genetic and environmental factors are thought to be responsible. It is estimated that one in every 1,200 people develop the condition every year. Because polymyalgia rheumatica does not often cause swollen joints, it may be hard to recognise.
What are the symptoms of polymyalgia rheumatica (PMR)?
- Severe and painful stiffness in the morning, especially in your shoulders, neck and thighs
- Overwhelming tiredness leading to feelings of depression
- Feeling unwell and having a slight fever
- Unexplained weight loss
How is PMR diagnosed?
There is no specific test to diagnose polymyalgia rheumatica. Your doctor will take into account your medical history, your symptoms and will undertake a physical examination. You may be sent for blood tests to check for inflammation but, as inflammation is a feature of other conditions such as rheumatoid arthritis, the blood tests will endeavour to rule those out. The three tests that may be used include:
- erythrocyte sedimentation rate (ESR)
- plasma viscosity (PV)
- C-reactive protein (CRP)
Anaemia is quite common in PMR so your doctor may test for this. If your doctor suspects the complication, giant cell arteritis, they may suggest a biopsy where a small piece of the artery is taken from the scalp and examined under a microscope. We take a closer look at GCA later in the article.
What treatments are available?
The main polymyalgia treatment is steroid treatment and in particular a corticosteroid medication called prednisolone. This can have a powerful effect on reducing inflammation and symptoms often improve significantly within a day or two of the start of the treatment. However most people will need to continue with the course of treatment for 2 years to prevent the symptoms returning. After a large initial dose, your GP will try to reduce the dose to avoid potential side effects such as osteoporosis. It is important to remember that you should not alter the dose or stop taking the medication unless advised by your doctor. Your body normally makes several of its own steroids in the adrenal glands but this stops whilst you are taking steroid medication. The body then needs a period of time to resume normal production of natural steroids before the drug is stopped completely.
If your symptoms are mild, you may be advised to take analgesic painkillers such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen. These will help ease the pain and stiffness.
If your polymyalgia symptoms don’t improve, you may be prescribed methotrexate tablets alongside the steroid tablets for better disease control. Methotrexate works by reducing the activity of the immune system and therefore reduces inflammation. As this drug can cause side effects such as nausea and mouth ulcers, it is important to have regular check-ups and blood tests to monitor your condition.
Your GP or pharmacist should issue you with a steroid card which shows your medication and its dosage. You should carry the card with you at all times.
Self-help and daily living
Because steroid treatment can increase the risk of osteoporosis, it is important to consider the other risk factors associated with this condition. Smoking or heavy drinking will both increase your risk of osteoporosis while a diet rich in calcium and vitamin D, combined with some weight-bearing exercise, will help to lower your overall risk.
Simple measures such as avoiding sitting in one place for a long time, will ease problems with stiffness. Taking a hot bath or shower in the morning or after exercise, will help to ease pain and stiffness.
You need to find the right balance between rest and activity. Walking is a great way of maintaining movement without making your symptoms worse. Physiotherapy, which involves exercises for the shoulders, can be helpful in reducing pain and maintaining mobility.
Steroid treatment reduces the amount of calcium absorbed from the gut and increases calcium loss through the kidneys. Therefore it is important to have a diet rich in calcium including oily fish, milk, cheese and other dairy products. Vitamin D is needed for the body to absorb and process calcium. Your body produces vitamin D when your skin is exposed to sunlight. It can also be sourced from oily fish, eggs and fortified cereals. A daily supplement of 400-800 international units (IU) may also be needed especially for people over the age of 60.
Polymyalgia Rheumatica Complications
Around one in five people with PMR will develop giant cell arteritis (GCA). This is a more serious condition and requires urgent medical attention. The symptoms of GCA are:
- Severe headaches and pain in the muscles of the head
- Tenderness at the temples
- Pain in the jaw, tongue or side of the face
- Swelling or pain in the scalp
- Blurred or double vision
If you would like more information on PMR, please click on this link to Arthritis Research UK:
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Some warning signs of health conditions shouldn’t be ignored, so if you would like to read our article advising when you should contact your GP, click on this link.
Finally, as we always say, if you have any concerns about your health, don’t suffer in silence. Speak to your GP or your local pharmacy for help and advice.