Polymyalgia Rheumatica (PMR) is a clinical syndrome that can be a manifestation of many pathological processes, including rheumatoid arthritis, cancer, and including giant cell arteritis (GCA). PMR usually affects persons older than 50 years, and women are affected twice as often as men. The disorder may have either an acute or insidious onset, producing pain and stiffness in the proximal musculature. Fatigue, depression, weight loss, and fever may also occur. In all likelihood, PMR is a disease of medium-sized and large arteries that is seen in many different entities, GCA and rheumatoid arthritis. The prevalence of PMR may equal that of rheumatoid arthritis in individuals older than 50 years. The two disorders often overlap in clinical presentation, and classification may sometimes present a problem. Symptoms and signs are nonspecific.
The differential diagnosis includes rheumatoid arthritis, polymyositis, occult malignant disease, infectious disease, myofascial pain syndromes, and functional abnormalities. In one study, the ESR was strikingly elevated in 99% of patients, hemoglobin levels were decreased in 47%, a2-globulin levels were abnormal in 33%, aspartate aminotransferase levels were elevated in 23%, and alkaline phosphatase levels were increased in 10%. An increased fibrinogen level and normal creatine kinase and aldolase levels are also common.
A dramatic response to corticosteroids (in 24 to 48 hours) helps confirm the diagnosis of PMR, although this finding is not specific. Because PMR and GCA are often parts of the same disease spectrum, therapy must be directed at both symptomatic relief and prevention of catastrophic visual loss. An initial daily regimen of low-dose prednisone (6 to 10mg) or nonsteroidal agents may control morning stiffness and pain. In the absence of ocular symptoms, PMR can be treated with maximal doses of nonsteroidal anti-inflammatory drugs. Prednisone (10 to 15mg daily) will give a more prompt therapeutic response, but the toxicity from long-term use at dosages greater than 7.5 mg/day is high. Usually, low-dosage maintenance can be achieved within weeks. Reassessment is mandatory if ocular or other symptoms develop; in such cases, the steroid dosage must be increased. Some patients require a low dosage of steroids for life; others may be weaned from steroids after 2-4 years.
Signs, symptoms & indicators of Polymyalgia Rheumatica
High ESR or elevated ESR
Counter Indicators
Normal ESR or elevated ESR
Fatigue on light exertion
Having a moderate/having a slight/having a high fever
Frequent/occasional unexplained fevers
Shoulder pain
Hip pain
Conditions that suggest Polymyalgia Rheumatica
Risk factors for Polymyalgia Rheumatica
Low DHEA Level
Low levels of DHEA have been associated with a wide variety of diseases, including inflammatory, autoimmune diseases such as rheumatoid arthritis and polymyalgia rheumatica.
Having low CD8 count
Reduced percentages and numbers of CD8 cells have been observed by different authors in untreated patients with active polymyalgia rheumatica (PMR).
Recent unexplained weight loss
Polymyalgia Rheumatica suggests the following may be present
Recommendations for Polymyalgia Rheumatica
Devil's Claw (Harpagophytum Procumbens)
Devil’s claw root has an anti-inflammatory property and has been used to treat rheumatic disorders. It can help reduce pain and inflammation associated with polymyalgia. Take 3 extract tablets, or simmer 1 tsp. of devil’s claw root in 1 cup of water for fifteen minutes. Drink three times daily for four weeks. Rest for two weeks, and then begin again.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Strongly counter-indicative |
| May do some good |
Glossary
Rheumatoid Arthritis
A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Insidious
A symptom or condition of gradual onset or development.
Proximal
Nearer to a point of reference such as an origin, a point of attachment, or the midline of the body.
Arthritis
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Malignant
Dangerous. mainly used to describe a cancerous growth -- when used this way, it means the growth is cancerous and predisposed to spreading.
ESR
Erythrocyte Sedimentaion Rate is a screening test and not considered diagnostic for any particular disorder. It is useful in detecting and monitoring inflammatory conditions, tuberculosis, tissue necrosis (tissue death), connective tissue disease, or an otherwise unsuspected disease in which symptoms are vague or physical findings are minimal.
Hemoglobin
The oxygen-carrying protein of the blood found in red blood cells.
Score
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Milligram
(mg): 1/1,000 of a gram by weight.
Anti-inflammatory
Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.
Steroid
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
DHEA
Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.
Autoimmune Disease
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
CD8
CD8 cells, also called suppressor and cytotoxic T-cells, play a role in fighting viral infections such as HIV. A T lymphocyte that secretes large amounts of gamma-interferon, a lymphokine involved in the body's defense against viruses. CD8 cells prevent the unnecessary formation of antibodies. A healthy adult usually has between 150 and 1,000 CD8 cells per cubic millimeter. In contrast to CD4 cells, people with HIV often have elevated numbers of CD8 cells, the significance of which is not well understood. Lab reports may also list the T-cell ratio, which is the number of CD4 cells divided by the number of CD8 cells. Since the CD4 count is usually lower and the CD8 count higher than normal, the ratio is usually low in people with HIV. A normal T-cell ratio is usually between 1.5 and 2.5 to 1. The expected response to effective combination anti-HIV treatment is an increase in CD4 count, a decrease in CD8 count, and an increase in the T-cell ratio.