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

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.
References in periodicals archive ?
Ito, "Clinical characteristics of polymyalgia rheumatica in Japanese patients: evidence of synovitis and extracapsular inflammatory changes by fat suppression magnetic resonance imaging," Modern Rheumatology, vol.
My patient is a 62-year-old pleasant woman who has been on prednisone at high dosages for years for her polymyalgia rheumatica. Due to chronic exposure of this exogenous steroid dosage and her body's long-term stress from battling this disease, her own adrenal functioning started to shut down.
A 78-YEAR-OLD MAN was diagnosed with polymyalgia rheumatica (painful inflammation of the arteries, usually in the shoulders and hips) by his longtime primary care physician.
Her background history included asymptomatic hiatus hernia, morbid obesity (BMI of 35.7), polymyalgia rheumatica, previous laparoscopic cholecystectomy, hypercholesterolaemia and hypertension.
Polymyalgia rheumatica (PMR) is characterised by clinical findings mainly in the shoulder and hip girdles, while in fibromyalgia syndrome (FMS) the main findings are the identification of tender points in the absence of inflammation.
Lymphoreticular malignancy and monoclonal gammopathy presenting as polymyalgia rheumatica. Br J Rheumatol 1987; 26:458-459.
At Christmas he diagnosed Polymyalgia Rheumatica, and prescribed steroids.
A history of hypertension, diabetes, or polymyalgia rheumatica points to vascular causes, and hyperthyroidism suggests that flashing lights may be phosphenes of Graves' disease.
latrogenic KS can develop after corticosteroid or immunosuppressive drug therapy due to systemic lupus erythematosus, rheumatoid arthritis, polymyositis, dermatomyositis, polymyalgia rheumatica and Behcet's disease, generally with ocular involvement.
The same low-quality trial evidence, however, did show an increased risk of possible NAION (defined as papillitis, optic neuritis, or both in the absence of temporal arteritis, polymyalgia rheumatica, and previous optic neuropathies).
Distal musculoskeletal manifestations in polymyalgia rheumatica: a prospective follow up study.
I was diagnosed with polymyalgia rheumatica about seven years ago.