Polymyalgia rheumatica (PMR) | Causes, symptoms, treatments

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Polymyalgia rheumatica (PMR) | Causes, symptoms, treatments

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Polymyalgia rheumatica (poly-my-al-ger ru-mah-ticker), or PMR, is a relatively common condition that causes stiffness and pain in muscles. Overview. Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders and hips.

Polymyalgia rheumatica – Illnesses & conditions | NHS inform.

Polymyalgia rheumatica is usually treated with a corticosteroid medication eg: prednisone. High doses are given initially and then gradually decreased or tapered to the lowest possible level at which symptoms are controlled. There is usually a quick response to corticosteroid treatment and symptoms tend to be dramatically decreased within a few days of starting the medication. Doses will be tailored to the individual according to how well the symptoms are being controlled.

Doses may need to be increased when the body is under stress, such as after surgery, injury, or during another illness. Most people can stop taking corticosteroid medication within two years, though some people may need to take low doses for several years. When a person is free of symptoms and has not needed to take medication for a few months the disease is considered to be in remission. Relapses which is when symptoms return may occur once corticosteroid treatment is stopped but symptoms will usually respond quickly if treatment is re-started.

Many people will relapse during the tapering of the corticosteroids to find the lowest possible dose. These relapses are treated by increasing the drug dose for a while then gradually reducing the dose again. While corticosteroids are very effective in treating PMR, long-term use of the medication can produce side effects. These include:. The need to manage the symptoms of the PMR needs to be balanced with the potential for side effects.

It is important to never abruptly stop taking corticosteroid medication. The dose needs to be gradually reduced until it’s at a level where it can be safely stopped. Regular monitoring for side effects is required during corticosteroid treatment and dose reduction.

Other treatments may be prescribed to manage reactions to corticosteroid medication eg: drugs that prevent bone thinning. Methotrexate, which is a drug that suppresses the activity of the immune system, may be given with corticosteroids in some patients, usually people whose symptoms flare up or who do not respond adequately to corticosteroids.

It may also be used to reduce the dosage of corticosteroid to minimise corticosteroid-related side effects. Other medications that may be used to treat the condition include non-steroidal anti-inflammatory medications NSAIDs. Alkaline phosphatase may be mildly increased. Serum albumin levels may be slightly decreased. Radiography of painful joints may rarely show abnormalities such as osteopenia, joint space narrowing, or erosions.

Magnetic resonance imaging MRI is not necessary for diagnosis, but MRI of the shoulder reveals subacromial and subdeltoid bursitis and glenohumeral joint synovitis in the vast majority of patients. MRI of the hands and feet demonstrates inflammation of the tendon sheaths in many patients.

Ultrasonography is very operator dependent but may be useful when the diagnosis is uncertain. Bursa ultrasonography may reveal an effusion within the shoulder bursae. The ultrasonography findings and those of MRI usually correlate well.

Why is this test important? Patients should be monitored for symptoms or signs of arteritis after treatment initiation, because low-dose corticosteroids such as prednisone do not prevent progression of PMR to GCA. If clinical signs of vasculitis develop, TAB should be performed. TAB may also be warranted in patients with PMR who are receiving low-dose corticosteroids if the clinical response is incomplete or if the ESR remains elevated or rises despite symptom resolution on corticosteroid therapy.

The goals of therapy in PMR are to control painful myalgia, to improve muscle stiffness, and to resolve constitutional features of the disease. Oral corticosteroids such as prednisone see sidebar are the first line of treatment. Nonsteroidal anti-inflammatory drugs NSAIDs may be helpful as adjuncts to corticosteroids during tapering, or alone in mild cases.

PMR is usually a self-limiting disease. If untreated, patients will have an impaired quality of life. With early diagnosis and correct therapy, patients have an excellent prognosis.

The average length of disease is 3 years. Generally, PMR is not associated with serious complications; however, patients treated with corticosteroids are at risk for long-term complications of corticosteroid therapy.

Every patient should be considered at risk for GCA. Corticosteroids are considered the treatment of choice because they often cause complete or near-complete symptom resolution and reduction of the ESR to normal.

However, they do not cure the disease. The low-dose corticosteroids used in PMR are almost certainly ineffective in the prevention of vasculitis progression. Nevertheless, controversy remains regarding the dose and duration of treatment. There are many volunteer opportunities available. Take part to be among those changing lives today and changing the future of arthritis. Help millions of people live with less pain and fund groundbreaking research to discover a cure for this devastating disease.

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Examples include alendronate and risedronate. Painkillers , such as paracetamol, or short courses of non-steroidal anti-inflammatory drugs NSAIDs , such as ibuprofen or naproxen, can help ease pain and stiffness. They can be taken at the same time as steroid tablets. There may be some situations where your doctor will want to prescribe a type of drug called a disease-modifying anti-rheumatic drug DMARD , alongside steroids.

The specialist may decide to prescribe a DMARD alongside steroid tablets, which may help to reduce the inflammation and lower the steroid dose. An example is methotrexate. Steroid treatment is usually very effective at treating polymyalgia rheumatica. Ensuring you get enough calcium and vitamin D , and that you do some weight-bearing exercise will reduce the risk of getting osteoporosis. Too much exercise is likely to make your symptoms worse, but activity usually helps to ease pain and stiffness in the muscles of the shoulders, hips and thighs.

Physiotherapy , including range of movement exercises for the shoulders, can help to reduce pain and maintain mobility. Weight-bearing exercise is good for maintaining bone strength and reducing the risk of osteoporosis. Weight-bearing exercise is anything like jogging, walking, tennis, dancing or lifting weights, where some force or the weight of the body is impacted on bones during the exercise.

This is in contrast to swimming, for example, where the water supports the weight of the body. Walking is usually the most suitable weight-bearing exercise for people with polymyalgia rheumatica. Sitting for any length of time may cause stiffness, making activities such as driving more difficult. Stop from time to time on a long journey to stretch your shoulders, arms and legs. Simple measures such as a hot bath or shower can help to ease pain and stiffness, either first thing in the morning or after exercise.

A pint of milk a day, together with a reasonable amount of other foods that contain calcium, should be enough. The best source of vitamin D is sunlight on bare skin. These can be bought from supermarkets and health food shops. You can also discuss this with a pharmacist. There are some at risk groups who are advised to take vitamin D supplements all year round, including:. We explain which foods are most likely to help and how to lose weight if you need to.

Find out more about exercising with arthritis and what types of exercises are beneficial for certain conditions. I was 57 when I developed polymyalgia rheumatica and giant cell arteritis.