 |
 |
 |
|
Polymyalgia rheumatica (PMR) is a type of arthritis that affects the muscles. It does not affect bones or joints, but causes muscles to become stiff, tender and very sore (inflammation). Even though the muscles are sore they do not become weak. PMR affects the muscles of the neck, shoulders, lower back, hips and thighs, and the pain is believed to be caused by the swelling of blood vessels in the muscles.
PMR is a clinical syndrome that can be a manifestation of many pathological processes, including rheumatoid arthritis, cancer, and Giant Cell Arteritis (GCA). GCA is a condition associated with polymyalgia rheumatica and sometimes occurs in people who suffer from PMR. The two disorders often overlap in clinical presentation, and classification may sometimes present a problem.
Incidence
PMR usually affects persons older than 50 years, and women are affected twice as often as men.
Signs & Symptoms
The disorder may have either an acute or insidious onset. Fatigue, depression, weight loss, and fever may also occur.
Diagnosis & Tests
The differential diagnosis includes rheumatoid arthritis, polymyositis, occult malignant disease, infectious disease, myofascial pain syndromes, and functional abnormalities. In one study, the ESR was strikingly elevated in 99% of patients, hemoglobin levels were decreased in 47%, a2-globulin levels were abnormal in 33%, aspartate aminotransferase levels were elevated in 23%, and alkaline phosphatase levels were increased in 10%. An increased fibrinogen level and normal creatine kinase and aldolase levels are also common. A dramatic response to corticosteroids (in 24 to 48 hours) helps confirm the diagnosis of PMR, although this finding is not specific.
Treatment & Prevention
Because PMR and GCA are often parts of the same disease spectrum, therapy must be directed at both symptomatic relief and prevention of catastrophic visual loss.
Complications
PMR causes the arteries on the upper front side of the head, called the temporal arteries, to narrow. The arteries can become blocked and this can result in loss of vision or even blindness.
|
|
 |
|
 |
Signs, symptoms & indicators of Polymyalgia Rheumatica:
Conditions that suggest Polymyalgia Rheumatica:
Recommendations and treatments for Polymyalgia Rheumatica: | | | | | Drug |  NSAIDs | An initial daily regimen of low-dose prednisone (6 to 10mg) or nonsteroidal agents may control morning stiffness and pain. In the absence of ocular symptoms, PMR can be treated with maximal doses of NSAIDs. Prednisone (10 to 15mg daily) will give a more prompt therapeutic response, but the toxicity from long-term use at dosages greater than 7.5 mg/day is high. Usually, low-dosage maintenance can be achieved within weeks. Reassessment is mandatory if ocular or other symptoms develop; in such cases, the steroid dosage must be increased. Some patients require a low dosage of steroids for life; others may be weaned from steroids after two to four years. |
|
| | | | |
KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Very strongly or absolutely counter-indicative | | | Highly recommended |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Alkaline
A substance having a pH above that of neutral water (7.0) when in solution. Signified as pH (potential of Hydrogen), alkaline fluids, such as the blood (pH about 7.4), have the ability to neutralize acids (solutions below pH 7.0). Metabolic wastes are acids, and the alkaline reserve of the blood neutralizes them until they are excreted.
Arterial (Arteries, Artery)
Blood that leaves the heart. When it leaves the right ventricle, it is venous blood; and when it leaves the left ventricle, through the aorta, it is fresh and oxygenated. After it has passed out to the capillaries and started to return, it is venous blood.
Arthritis (Arthritic)
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Corticosteroid (Corticosteroids)
Steroid hormone produced by the adrenal cortex.
Hemoglobin
The oxygen-carrying protein of the blood found in red blood cells.
Insidious
A symptom or condition of gradual onset or development.
Malignant (Cancerous)
Dangerous. Mainly used to describe a cancerous growth -- when used this way, it means the growth is cancerous and predisposed to spreading.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
NSAID (NSAIDs)
Non-steroidal anti-inflammatory drug.
Rheumatoid Arthritis
A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).
Steroid (Steroids)
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Last updated: Nov 08, 2009
|
 |
|
|
