polymyalgia rheumatica


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Related to polymyalgia rheumatica: prednisone, fibromyalgia

Polymyalgia Rheumatica

 

Definition

Polymyalgia rheumatica is a syndrome that causes pain and stiffness in the hips and shoulders of people over the age of 50.

Description

Although the major characteristics of this condition are just pain and stiffness, there are reasons to believe it is more than just old-fashioned rheumatism. Patients are commonly so afflicted that their muscles atrophy from disuse. A similar complaint of such weakness is also seen in serious muscle diseases. Moreover, some patients develop arthritis or a disease called giant cell arteritis or temporal arteritis.

Causes and symptoms

This condition may arise as often as once in every 2,000 people. Rarely does it affect people under 50 years old. The average age is 70; women are afflicted twice as often as men. Along with the pain and stiffness of larger muscles, headache may add to the discomfort. The scalp is often tender. Pain is usually worse at night. There may be fever and weight loss before the full disease appears. Patients complain that stiffness is worse in the morning and returns if they have been inactive for any period of time, a condition called gelling. Sometimes the stiffness is severe enough that it causes frozen shoulder.

Diagnosis

Symptoms are usually present for over a month by the time patients seek medical attention. A mild anemia is often is often present. One blood test, called an erythrocyte sedimentation rate, is very high, much more so than in most other diseases. The most important issue in evaluating polymyalgia rheumatica is to check for giant cell arteritis. Giant cell arteritis can lead to blindness if lift untreated.

Treatment

Polymyalgia rheumatica responds dramatically to cortisone-like drugs in modest doses. In fact, one part of confirming the diagnosis is to observe the response to this treatment. It may also respond to nonsteroidal anti-inflammatory drugs (NSAIDs). Temporal arteritis is also treated with cortisone, but in higher doses.

Prognosis

The disease often remits after a while, with no further treatment required.

Key terms

Anemia — A condition in which the blood lacks enough red blood cells (hemoglobin).
Atrophy — Wasting away of a body part.
Frozen shoulder — A shoulder that becomes scarred and cannot move.
Giant cell arteritis — Also called temporal arteritis. A condition which causes the inflammation of temporal arteries. It can cause blindness when the inflammation effects the ophthalmic artery.
NSAIDs — Non-steroidal anti-inflammatory drugs like aspirin, ibuprofen, and naproxen.
Syndrome — A collection of abnormalities that occur often enough to suggest they have a common cause.

Resources

Books

Griggs, Robert C. "Episodic Muscle Spasms, Cramps, andWeakness." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.

pol·y·my·al·gi·a rheu·ma·ti·ca

a syndrome within the group of collagen diseases different from spondylarthritis or from humeral scapular periarthritis by the presence of an elevated sedimentation rate; much commoner in women than in men.

polymyalgia rheumatica

[-mī·al′jə]
Etymology: Gk, polys + mys, muscle, algos, pain, rheuma, flux
a chronic, episodic inflammatory disease of the large arteries that usually develops in people over 60 years of age. The disease primarily affects the arteries in muscles. It is characterized by pain and stiffness of the back, shoulder, or neck that is usually more severe on rising in the morning. There may also be a cranial headache, which affects the temporal and occipital arteries, causing a severe throbbing headache. Serious complications of polymyalgia rheumatica include arterial insufficiency, coronary occlusion, stroke, and blindness. Patients with the disease usually have a high erythrocyte sedimentation rate. The disease may follow a self-limited course. However, adrenocorticosteroids have proved highly effective in reducing inflammation and in speeding recovery.

polymyalgia rheumatica

Polymyalgia Internal medicine A condition characterized by an abrupt onset of myalgia and arthralgia of the neck and proximal 'girdle' muscles, most prominent in the morning and after rest; systemic Sx are vague–aching of ≥ 30 mins, affecting 2+ major joints, in descending order, shoulder, hips and thighs, or neck/torso Pt profile > age 70; ♀:♂, 2:1 Clinical Pain exacerbated by movement, fatigue, malaise, weight loss, depression, low-grade fever Lab ↑ ESR, anemia of chronic disease, mild ↑ LFTs, ↑ WBCs, ↑ Igs, ↑ acute phase reactants Management NSAIDs, aspirin; if brutal, corticosteroids; PR may be associated with other inflammatory conditions, giant cell/temporal arteritis, connective tissue disorders, CA

polymyalgia rheumatica

An uncommon disease of the elderly causing muscle pain and stiffness in the hips, thighs, shoulders, and neck. The cause is uncertain. A striking feature is the difficulty in getting out of bed in the mornings. Corticosteroid drugs are effective. Some affected people also suffer from TEMPORAL ARTERITIS (giant cell arteritis) and may require urgent treatment with corticosteroid drugs to prevent blindness. About half the patients with giant cell arteritis suffer from polymyalgia rheumatica.

polymyalgia rheumatica

; PMR musculoskeletal pain syndrome affecting shoulders and arms of older women; of unknown pathology; treated with systemic steroids

polymyalgia rheumatica (pˈ·lē·mīˑ·al·jē· rōō·maˑ·ti·k),

n a condition in older patients whose symptoms include quick onset of pain or loss of motion in the shoulder or pelvic region, anemia, fever, weight loss, and malaise. Elevated erythrocyte sedimentation rate accompanies the symptoms. See also erythrocyte sedimentation rate.
References in periodicals archive ?
The spectrum of polymyalgia rheumatica in northwestern Spain: incidence and analysis of variables associated with relapse in a ten year-study.
My patient is a 62-year-old pleasant woman who has been on prednisone at high dosages for years for her polymyalgia rheumatica.
In temporal arteritis systemic symptoms generally precede the ocular sudden event including, polymyalgia rheumatica, loss of appetite, fever, and general malaise.
PMR, or polymyalgia rheumatica, is a condition in which you have many (poly) painful muscles (myalgia).
Polymyalgia rheumatica is a condition that causes widespread inflammation of muscles.
Re: the polymyalgia rheumatica reader ["Myalgia Means 'Muscle Pain,'" May/June '07]: I'm 68 years old and was diagnosed with this painful condition several years ago.
The 202 controls consisted of 39 patients with connective tissue diseases (23 Sjbgren syndrome, 14 systemic lupus erythematosus, 1 mixed connective tissue disease, and 1 dermatopolymyositis); 12 with other rheumatic diseases (8 polymyalgia rheumatica and 4 psoriatic arthritis); 39 with various viral infections [15 HCV, 11 hepatitis B virus (HBV), 4 parvovirus (Pv) B19, and 9 Epstein-Barr virus (EBV)]; 6 with Lyme disease; 15 with autoimmune thyroid diseases (AITD), and 17 with different kinds of cancer, as well as 74 healthy persons who, as a group, were frequency-matched by sex and age with the RA patients (70 women and 4 men; mean age, 63 years; range, 36-74 years).
Many of these patients are in the HLA-DRBI*01 group, a phenotype at risk of developing polymyalgia rheumatica and rheumatoid arthritis.
There were no typical symptoms of GCA, such as headache, visual disturbance, or polymyalgia rheumatica.
Such patients, of course, need to be evaluated for other conditions such as polymyalgia rheumatica and temporal arteritis, which may have been unmasked by statin therapy, as well as hypothyroidism, which can also elevate CK levels.
Of the patients studies, 14 (27%) were taking corticosteroids as therapy for rheumatoid arthritis, 12 (24%) were being treated for asthma or chronic obstructive pulmonary disease, 7 (14%) were being treated for polymyalgia rheumatica, and 18 (35%) had other conditions, according to the study.