Polymyalgia rheumatica: what is it, symptoms, treatment

What is polymyalgia rheumatica?

Polymyalgia rheumatica - an inflammatory disease that leads to pain and muscle stiffness, especially in the shoulder girdle. The symptoms of polymyalgia rheumatica usually get worse in the morning. Most people who develop polymyalgia rheumatica are over the age of 65. It rarely affects people under the age of 50.

Polymyalgia rheumatica is associated with another inflammatory disorder called giant cell arteritis, which manifests itself in the form of headaches, loss of vision, pain in the jaw. Often these two diseases are related to each other and manifest together.

Causes of polymyalgia rheumatica

The exact cause of polymyalgia rheumatica is unknown. The following factors seem to be involved in the development of this condition:

• Genetic. Certain genes and gene variations can increase susceptibility to this disease.
• Environmental impact. New cases of polymyalgia rheumatica tend to develop cyclically and have a certain seasonality. This suggests that an environmental trigger such as a virus may play a role.
• Giant cell arteritis. Polymyalgia rheumatica and giant cell arteritis have many similarities. Giant cell arteritis is manifested by inflammation in the intima of the arteries, most often the temporal ones. Giant cell arteritis leads to headaches, jaw pain, vision problems, and scalp soreness. If left untreated, it can lead to stroke or blindness.

About 20 percent of people with polymyalgia rheumatica have signs and symptoms of giant cell arteritis. About half of people with giant cell arteritis may have polymyalgia rheumatica.

Risk factors

• Age. Polymyalgia rheumatica affects mainly the elderly. The average age of onset is 70 years.
• Floor. Women get sick 2 times more often than men.
• Race and geographic region. Polymyalgia rheumatica is most common in northern European populations.

Symptoms of polymyalgia rheumatica

Pain and stiffness in the neck and shoulders are the most common symptoms of polymyalgia rheumatica. Pain and stiffness can gradually spread to other areas, such as the buttock and thighs. These symptoms usually affect both sides of the body.

Other common symptoms of polymyalgia rheumatica include:

• Stiffness or pain in your shoulders (often the first symptom)
• pain in the muscles of the neck, shoulders, buttocks, hips;
• muscle stiffness, especially in the morning or after long periods of inactivity;
• limited range of motion in the shoulder girdle;
• Pain or stiffness in the wrists, elbows, or knees (less common)

General signs and symptoms may also occur, including:

• low body temperature;
• chronic apathy;
• a general feeling of not feeling well (malaise);
• lack of appetite;
• unintentional weight loss;
• depression.

Complications

Symptoms of the disease can significantly affect a person's ability to carry out daily activities. Pain and stiffness can make it difficult to perform the following tasks:

• getting out of bed, from a chair, getting out of the car;
• bathing or brushing your hair;
• dressing (putting on a coat).

In addition, people with polymyalgia rheumatica are more likely to develop peripheral arterial disease.

When is it necessary to see a doctor?

See your doctor if you experience pain or stiffness in your upper shoulder girdle or hips that interferes with sleep. limits the ability to engage in daily activities (such as dressing), general fatigue, increased body temperature.

If you have been diagnosed with polymyalgia rheumatica, then you need to be monitored by a rheumatologist due to the alertness regarding the development of giant cell arteritis. It is necessary to be constantly monitored by a rheumatologist to control symptoms that may indicate the onset of the development of this disease.

If you experience any of the following symptoms, see your rheumatologist immediately:

• new, unusual, or persistent headaches;
• jaw pain;
• blurry or loss of vision.

Diagnostics

Symptoms of polymyalgia rheumatica may be similar to those of other inflammatory conditions, including systemic lupus erythematosus and rheumatoid arthritis. To make an accurate diagnosis, the doctor will conduct a physical examination and several tests to check for inflammation and blood abnormalities.

During the exam, the doctor can gently move the neck, arms, and legs to assess range of motion. If polymyalgia rheumatica is suspected, your doctor may prescribe blood tests for signs of inflammation in the body. These analyzes will measure sedimentation rate of erythrocytes and level C-reactive protein. Abnormally high sedimentation rate and elevated C-reactive protein levels usually indicate inflammation.

The doctor may also prescribe Ultrasound to check for inflammation in joints and tissues. Ultrasound uses high-frequency sound waves to create detailed images of soft tissue in different parts of the body. This can be very helpful in distinguishing polymyalgia rheumatica from other conditions that cause similar symptoms.

Because there is a link between polymyalgia rheumatica and giant cell arteritis, your doctor may do a biopsy. Biopsy - A simple, low-risk procedure that involves removing a small tissue sample from an artery in your temple. The sample is sent to a laboratory and analyzed for signs of inflammation. A biopsy is only needed if the doctor suspects inflammation in the blood vessels.

Treatment of polymyalgia rheumatica

Glucocorticoids.

Low-dose oral glucocorticoids such as prednisone are most commonly prescribed. The daily dose at the start of treatment is usually 12 to 25 milligrams per day.

After the first two to four weeks of treatment, it is most often recommended to gradually reduce the dosage depending on the activity of the disease. The goal is to take as low a dose as possible without causing an exacerbation of the disease. Most often, it is necessary to continue treatment with glucocorticoids for at least a year.

With a rapid dose reduction, the likelihood of relapse increases significantly. In 30-60% of people with polymyalgia rheumatica, there is at least one exacerbation when the dose of HA is reduced.

Monitoring of side effects.

Long-term use of glucocorticoids can lead to a number of serious side effects. A rheumatologist will closely monitor these manifestations.

Possible side effects:

• weight gain;
• osteoporosis (loss of bone density);
• high blood pressure (arterial hypertension);
• diabetes;
• cataract (cataract).

Calcium and vitamin D preparations.

To help prevent glucocorticoid-induced bone loss, calcium supplements with vitamin D should be taken. The American College of Rheumatology recommends the following daily dosages for a person taking HA: 1,200 to 1,500 milligrams of calcium, 800 to 1,000 IU of vitamin D.

Methotrexate.

The joint guidelines of the American College of Rheumatology and the European Antirheumatic League recommend the use of methotrexate in combination with HA in some patients. Most often, methotrexate is added in severe cases or when HA is ineffective.

Physiotherapy.

Talk to your rheumatologist about whether physical therapy is a good option for you.

Non-steroidal anti-inflammatory drugs (NSAIDs). Nonsteroidal anti-inflammatory drugs such as ibuprofen, diclofenac, naproxen are usually not recommended for relieving symptoms of polymyalgia rheumatica.

Help at home

Use assistive devices. Use grocery carts, shower grips, and other aids to make your daily tasks easier. Take steps to minimize the risk of falls, such as wearing low-heeled shoes. Talk to your rheumatologist about whether using a cane or other walking device to prevent falls is right for you.

Prevention of polymyalgia rheumatica

Eat right. Eat a diet of fruits, vegetables, whole grains, and lean meat and dairy products. Limit salt (sodium) intake in your diet to prevent fluid build-up and high blood pressure.

Exercise regularly. Talk to your rheumatologist about exercises that are right for you to maintain a healthy weight and strengthen bones and muscles.

Disease prognosis

Polymyalgia rheumatica is usually a self-limiting disease, and patients who do not receive treatment often feel unwell and have a poorer quality of life. The disease has an excellent prognosis with rapid diagnosis and adequate therapy.