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Susan B. Ward, MD, Rheumatology
The Chester County Hospital
Published: September 21, 2009
Body aches and joint pain are not always something you "just have to live with." Sometimes the causes are specific diseases that are identifiable, treatable and curable. One such disease is Polymyalgia Rheumatica or PMR, which is not as well known as Fibromyalgia or Chronic Fatigue Syndrome, but still has symptoms that can be debilitating. Commonly, there can be a delay of diagnosis because the symptoms are so non-specific and generalized. But unlike Fibromyalgia and Chronic Fatigue Syndrome, there is a blood test for PMR that helps to make the diagnosis when appropriate clinical symptoms are present. PMR is treatable and curable.
The annual incidence of PMR varies geographically, but in this region, the prevalence is about 700 cases per 100,000 people over the age of 50, making it relatively common. PMR is classically characterized by aching in the morning and severe pain and stiffness in the shoulders, hips, neck or torso in people who are older than 50. Do you have trouble dressing, fastening a bra, pulling a shirt over your head, or putting on socks or stockings? Symptoms can also include malaise, fatigue, weight loss and fever. Some patients report swelling and pain in their hands, wrists, ankles and tops of their feet.
There seems to be a cluster of cases presenting themselves in the spring and fall. This suggests that the initial trigger may be a virus that stimulates the immune system. The over-active immune system then gives the person a feeling of fatigue as if you are fighting off something. Actually, the virus or other trigger is no longer present, but the immune system doesn't realize this. We know the immune system is activated because blood tests that reflect inflammation (such as the sedimentation rate, CRP and IL2) are all elevated.
If you are experiencing these symptoms, see your primary care physician who can usually make the diagnosis and start treatment. At your initial visit, some laboratory blood tests may be ordered before beginning treatment. Sometimes your doctor may request a consultation with a rheumatologist, a physician specializing in people with over-active immune systems disorders such as Lupus or Rheumatoid Arthritis.
The rheumatologist will need to rule out other diseases that commonly mimic PMR, such as Myositis where there is muscle weakness not pain, early Rheumatoid Arthritis, Hypothyroidism, Fibromyalgia or mechanical joint problems like Bursitis or Tendonitis. There are also cancers that stimulate the immune system and mimic PMR. This work-up by the rheumatologist may include a history, physical and X-rays of the affected joints, usually the hands or shoulders. Also, laboratory tests would be ordered.
It is important to address PMR because of its link with a disease called Temporal Arteritis that can cause blindness. It is characterized by a very high sedimentation rate, headache and scalp tenderness over the temple area and pain in the jaw when chewing food, like hard bread or meat. An additional physician's referral may be made to an ophthalmologist.
PMR treatment is designed to slow down the immune system which requires corticosteroids, potent anti-inflammatory medications. The body usually responds promptly to a low-dose oral steroid that can be taken in the morning. This medication is tapered down slowly based on symptoms and sedimentation rate. In about 2% of people, there is a rare re-activation of the immune system, requiring longer therapy. The general course of treatment is usually about 12-18 months.
The important message is "don't just live with the pain," seek help and feel better.
This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.
Last Updated: 9/24/2009