Polymyalgia Rheumatica (PMR)
Polymyalgia rheumatica is a condition where certain muscle groups become inflamed causing pain and stiffness especially in the shoulders.
Although polymyalgia is a chronic (on going) disease, it usually responds well to treatment and it does not cause any progressive disability or deformity.
Polymyalgia may also be associated with another condition called giant cell arteritis (also known as temporal arteritis). In this condition arteries in the temples and in other parts of the body become inflamed. If the arteries to the eyes are affected, this can lead to blindness. Approximately 20% of people with polymyalgia also have signs of giant cell arteritis and as many as 50% of people with giant cell arteritis also have polymyalgia. Polymyagia and giant cell arteritis may be variations of the same disease.
Polymyalgia usually occurs after the age of 50 years, with the average onset age being 70 years. Women are two to three times more likely to develop polymyalgia than men are. It affects about one in 2000 people and is generally more common in Caucasian people.
1. Latest News
2. Symptoms and Treatments
Note: Always seek advice from a doctor before beginning any listed treatments. Treatments can affect everyone differently.
The most common symptoms of polymyalgia are pain and stiffness caused by inflammation in the joints and surrounding tissues. Symptoms may come on suddenly or appear gradually over several weeks. Symptoms are particularly bad first thing in the morning or after being inactive for a long time.
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Aches or pain in your shoulders (which is often the first symptom)
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Aches or pain in your neck, upper arms, buttocks, hips or thighs
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Stiffness in affected areas,
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Limited range of motion in affected areas
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Pain or stiffness in your wrists, elbows or knees (which is less common)
Other polymyalgia symptoms include
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Headaches
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Fever and/or night sweats
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Fatigue and loss of energy
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Loss of appetite
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Depression
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Weight loss
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Mild anaemia
It is important to see your doctor if you experience aches, pains or stiffness of a new nature, if they disrupt your sleep or if the inhibit your ability to perform daily living tasks, such as getting dressed
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Medical Treatments
Professional Support:
Working with a trained practitioner can assist you to develop skills to calm anxiety and can also equip you with knowledge to find your next steps towards wellness. Please ensure that you find a practitioner who understands how to navigate the territory of complex chronic health conditions.
Oral corticosteroids for Polymyalgia:
e.g (prednisone) High doses of a corticosteroid are given initially and the dose is gradually decreased (or tapered) to the lowest possible level at which symptoms are controlled. Corticosteroid treatment is usually fast acting and only takes a few days to start reducing symptoms.
Doses need to be managed with your doctor and may need to be increased when the body is under stress, such as after surgery, injury, or during another illness.
Most people can stop taking corticosteroids within two years, however some people may need to take low doses ongoing for several years. When a person is symptom free without medication, the disease is considered to be in remission.
Symptoms may return once corticosteroid treatment is stopped but will usually respond quickly once medication is re-started. Many patients relapse during the tapering of the corticosteroids to find the lowest possible dose. These relapses are treated by increasing the drug dose for a while then gradually reducing the dose again.
While corticosteroids are very effective in treating polymyalgia, long-term use of the medication can produce side effects. These include:
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Increased susceptibility to infections
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Increased appetite or weight gain
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Puffiness of the face
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Thinning and easy bruising of the skin
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High blood sugar levels
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Osteoporosis — the loss of bone density and weakening of bones
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High blood pressure (hypertension)
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Diabetes
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Cataracts — a clouding of the lenses of your eyes
The need to manage the symptoms of the polymyaligia needs to be balanced with the potential for side effects. Dosage should be managed closely with your doctor and note it is important to never abruptly stop taking corticosteroid medication.
Regular monitoring for side effects by your doctor is required during corticosteroid treatment and dose reduction. Other medications may be prescribed to manage reactions to corticosteroid medication (eg: drugs that prevent bone thinning).
Methotrexate for Polymyalgia:
is a medication which suppresses the activity of the immune system. It may be prescribed alongside corticosteroids for some patients, usually patients whose symptoms flare up or who do not respond adequately to corticosteroids. It may also be used to reduce the dosage of corticosteroid to minimise corticosteroid related side effects.
Calcium and vitamin D supplements for Polymyalgia:
Your doctor will likely prescribe daily doses of calcium and vitamin D supplements to help prevent bone loss caused by corticosteroid treatment.
Pneumonia vaccine for Polymyalgia:
A pneumonia vaccine may be recommended if you are taking 20 milligrams or more of prednisone a day. Discuss with your doctor.
NSAIDs (non-steroidal anti-inflammatory medications) for Polymyalgia:
can help to reduce inflammation and lessen pain but are not as effective as corticosteroids in providing symptom relief. Discuss with your doctor.
Physical therapy for Polymyalgia:
some polymyalgia patients may benefit from physical therapy, low impact exercise and streching if they have had limited activity because polymyalgia for some time. Discuss with your doctor about whether physical therapy is a good option if you're trying to regain strength, coordination and the ability to perform everyday tasks.
Diet for Polymyalgia:
Eating a healthy balanced diet can help manage symptoms
Rest for Polymyalgia:
Getting adequate rest can help to manage symptoms also
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​Mindfulness for Polymyalgia:
Meditative technique that empowers people to deal with pain and stress of arthritis. Mindfulness is a set of skills for healing, intuition, insight, calmness, focus, resilience and hope that you can develop to counter the stresses that chronic illness brings. You can literally "train your mind to promote healing. Mindfulness has a positive flow on affect into every aspect of a person’s life. More info
Massage:
can help to soothe sore joints and muscles, to ease anxiety or to improve sleep.
Tai Chi for Polymyalgia:
An ancient martial art/exercise that has been used to help patients
Acupuncture and Magnetic field therapy: have been reported to be effective in relieving symptoms in some people.
Boswellia Serrate (Indian frankincense):
is a herb which has anti-inflammatory and pain relieving properties. It may help patients with polymyalgia. It may ause heartburn in some people.
Tumeric for Polymyalgia:
can reduce pain and swelling by blocking inflammatory cytokines and enzymes.
Cat’s Claw (Uncaria tomentosa):
is a natural anti-inflammatory which may help some polymyalgia
Fish Oil (Omega-3 fatty acids EPA and DHA):
blocks inflammatory cytokines and prostaglandins, and are converted by the body into powerful anti-inflammatory chemicals called resolvins. May help polymyalgia patients.
Gamma Linolenic Acid (GLA):
is an omega-6 fatty acid that the body converts into anti-inflammatory chemicals. May help to provide relief
Curcumin and Ginger for Polymyalgia:
have inflammatory properties and studies have shown it to be very effective in pain management.
Green Tea:
contains compounds that have antioxidant and anti-inflammatory properties that may be helpful in combating pain.
Vitamins and Minerals for Polymyalgia:
Polymyalgia patients should ensure that they have healthy levels of the following minerals and vitamins to reduce pain.
Calcium - necessary for good bone health
Vitamin C - is an antioxidant that also has anti-inflammatory properties
Vitamin D - Your body needs vitamin D to absorb and process calcium. Getting sunlight and eating oily fish are good sources of vitamin D.
Vitamin K- consists of vitamins K1 and K2. Maintaining adequate vitamin K levels is crucial for bone mineralisation, blood clotting, cell growth, and blood vessel health. Vitamin K1 (phylloquinone) has anti-inflammatory effects.
Anti-inflammatory diet:
may help provide relief for some patients. More info here
3. Diagnosis and Tests
Alternative Treatments
When symptoms are sudden and dramatic, polymyalgia may be relatively easy to be diagnosed. However, when symptoms develop gradually it may be less obvious that polymyalgia is the cause.
The symptoms of polymyalgia can be similar to those of certain other medical conditions including rheumatoid arthritis, osteoarthritis, polymyositis, and fibromyalgia. Other conditions should be ruled before a diagnosis of polymyalgia can be made. There is no specific test for polymyalgia, but there are blood tests that can assist with diagnosis.
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Blood tests: erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) – can be used to check the levels of inflammation in the body.
If the ESR and CRP test results are normal, it’s unlikely that polymyalgia rheumatica will be diagnosed.
Sometimes the ESR may be normal and the CRP may be raised, which would be more likely to indicate a positive diagnosis. Hence both of these blood tests are usually carried out at the same time.
Inflammation is common in many conditions and high levels don't automatically mean you have polymyalgia rheumatica.
Further tests may be performed to help rule out other conditions that cause inflammation e.g a test for rheumatoid factor and anti-CCP antibodies may be carried out to rule out rheumatoid arthritis.
Blood tests can also help determine:
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whether there's an infection in the blood
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how well some of the organs, such as your kidneys, are working
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whether the thyroid gland is over or underactive, both conditions can cause muscle pain
A urine test may also be performed to check how well the kidneys are functioning.
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Imaging tests: may be helpful in the diagnosis of polymyalgia. Ultrasound can show tissue inflammation and may be used to distinguish polymyalgia from other conditions that cause similar symptoms. Magnetic resonance imaging (MRI) may be used to identify other causes of shoulder pain, such as degenerative joint changes.
4. Similar Conditions
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Arthritis, polymyositis, and fibromyalgia
