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Polymyalgia Rheumatica

Introduction

Polymyalgia-Rheumatica

I was diagnosed with Polymyalgia Rheumatica (PMR) back in April this year due to an accident at work.

I damaged the muscle at the top of my leg at work, by lifting boxes on March the 8th 2006. A couple of days later I was in agony with the pain in the muscles in both legs. I took this to be the result of my good leg over compensating for the damaged one. As the week went on, my arms and shoulders were beginning to give me problems as well.

I continued to struggle whilst in severe pain until eventually I had to see my GP. My doctor examined me and informed me that the muscles at the top of my leg were badly inflamed. A series of blood tests showed that I did in-fact have the disease PMR and the inflammation had spread all over my body…..

What a horrible disease PMR is! It usually strikes people over 50 years of age. It is very painful and attacks all the large muscles in the body. It can come on without any warning and can either go just as quick, or can be with you permanently. It is usually treated with Prednisolone (steroids).

For anyone who has ever suffered with PMR you will know how painful this disease is. It makes you feel very ill and resembles being hit by a steamroller. One person who had the disease commented that it was like having toothache all over the body. I think I would agree with him. At my worst I could not stand up or walk and felt like my whole body was suffering a severe bout of the flu.

Un-till February 2006 (this year), I was super fit, didn’t suffer colds or flu and felt extremely healthy. This disease has hit me with a vengeance! I am glad that I was fit, I feel that it helped me to start to get better quickly, once I began the steroids.

I now take each day as it comes. One day I can feel very good, the next I feel quite poorly again, but I will not give in to it. I am a great believer in mind over matter and positive thinking and hope this will help me to cope with this horrible illness in the coming months as it could be some time before I finally get free of it.

Any information, feedback or comments on Polymyalgia Rheumatica would be greatly appreciated. This disease is not well known, you can have good days, as well as bad days therefore, people do not understand how ill you can feel or actually be. It is like having a silent disease, that no one has ever heard of!

What is polymyalgia rheumatica and who does it affect?

Polymyalgia rheumatica (PMR) is a condition which causes inflammation of large muscles. ‘Poly’ means many, and ‘myalgia’ means muscle pain. The exact cause of PMR is not known.

PMR mainly affects people over the age of 50. It is rare in people under 50. About 4 in 10,000 people over the age of 60 develop PMR each year. The average age of patients is 74. Women are three times more likely to be affected than men. There is also a higher incidence among Caucasians than any other ethnic group.

What are the symptoms of polymyalgia rheumatica?

The usual symptoms are stiffness, pain, aching and tenderness of the large muscle groups especially around the shoulders, hips, pelvis and back. The stiffness is usually worst first thing in the morning or after resting. Getting out of bed may be very difficult. The stiffness often eases a little the day goes on.

Inflammation and swelling sometimes occurs in other ‘soft tissues’ of the body. For example, tendons may become inflamed (tenosynovitis), your hands or feet may become slightly swollen, and some joints may also become slightly swollen.

Other general symptoms may also occur. These include weakness, tiredness, depression, night sweats, mild fevers (occasionally), generally feeling ill, loss of appetite and weight loss.

What is the treatment for polymyalgia rheumatica?

PrednisoloneA steroid medicine such as prednisolone is the usual treatment. Steroids work by reducing inflammation. Treatment usually works quickly, within a few days. After starting treatment, the improvement in symptoms over 2-3 days is often quite dramatic.

Treatment is usually started with a medium dose – usually about 15 mg per day. This is then reduced gradually to a lower ‘maintenance’ dose. It may take several months to gradually reduce the dose. The maintenance dose needed to keep symptoms away varies from person to person. Usually it is between 5 and 8 mg per day.

You are likely to need treatment for at least two years. In some people the condition goes away, so the tablets can be stopped after 2-3 years. However, many people need treatment for several years, sometimes for life. If you stop taking the steroid tablets too soon, the symptoms return.

Are there any complications with polymyalgia rheumatica

About 1 in 20 people on treatment for PMR (and 7 in 20 with untreated PMR) develop giant cell arteritis (temporal arteritis). This is a related condition which causes inflammation of arteries (blood vessels). The arteries most commonly affected are those which pass over the temples (the sides of the forehead next to the eyes). The eye can be affected in some cases. This can lead to serious eye problems, even blindness. Rarely, other arteries such as those going to the brain are affected.

What is the long term outlook?

With careful monitoring and appropriate treatment, most patients with PMR have a normal life span and lifestyle. The success of therapy is related to prompt diagnosis, aggressive treatment and careful follow-up to prevent or minimize side effects from the medications.

What is Giant Cell Arteritis?

Some people with PMR develop a related condition called giant cell arteritis which can be more serious.

Giant-Cell-ArteritisAbout 1 in 20 people on treatment for PMR (and about 7 in 20 with untreated PMR) develop giant cell arteritis (temporal arteritis). This is a related condition which causes inflammation of arteries (blood vessels). The arteries most commonly affected are those which pass over the temples (the sides of the forehead next to the eyes). The eye can be affected in some cases. This can lead to serious eye problems, even blindness. Rarely, other arteries such as those going to the brain are affected.

If you develop giant cell arteritis, you should start treatment as soon possible after symptoms develop. It is treated with a much higher dose of steroids than PMR.

Other symptoms. Tell a doctor urgently if you develop any of the following symptoms.

  • Headache or tenderness on one side of your head.
  • Pain in your jaw when you chew which eases quickly when you rest the jaw muscles.
  • Sudden loss of vision, or any other sudden visual problem in one eye.
  • Weakness, numbness, deafness or any other nerve-related symptom.

The exact causes of PMR and GCA illnesses is unknown.

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