Polymyalgia Rheumatica

Below are videos and a written text about polymyalgia rheumatica, PMR.

Polymyalgia rheumatica is an inflammatory disorder causing muscle and joint aches and stiffness across the neck, both shoulders and pelvis. It develops gradually over a few weeks to months and often will come with fever, loss of appetite and fatigue. 

The exact cause is unknown, but likely due to genetic markers, or infection, or both. 

Those affected will be over the age of 50, usually over 70 and more often female and of European descent. The episodes are longer than 2 weeks and cause morning stiffness for more than 45 minutes. These symptoms are usually better later in the day, compared to osteoarthritis which can become worse towards evening.

Muscle weakness can occur because of pain. The pain is worse with movement and can radiate through the fascia of the arms and legs and into bursa (these are protective cushions around the joints.) The hands and feet can also hurt. 

Before the diagnosis is made, a good history and investigations need to be performed. Infection, malignancy, and giant cell arteritis, (temporal arteritis causing severe headache, scalp tenderness, later visual loss, stroke, even death) need to be excluded.

Apart from an examination for tenderness and other causes, bloods will need to be drawn: A Full or Complete Blood Count; C reactive protein – which is usually moderately raised, Liver function tests and electrolyte and creatinine testing as cortisone is used in the treatment of PMR.

Additional testing includes:

TSH for fatigue, Rheumatoid Factor and, if positive, anti CCP (anticyclic citrullinated peptides) which are raised in rheumatoid arthritis. CK for muscle disease like polymyositis, and ANA (antinuclear antibodies) for autoimmune disease.

A rheumatologist can be invaluable in excluding disease like RA.

Corticosteroids are powerful anti-inflammatory drugs, more powerful than Non-Steroidal Anti-inflammatories (NSAIDs) but they do carry the risk of more serious long term side-effects, like skin changes, bruising, mood changes, osteoporosis, aggravation of diabetes, hypertension, cataracts, glaucoma, fluid retention and heart failure, and increased risk of infection. A basal bone density test – an X-ray to assess fragility of bones – is important.

Usually 15mg for three weeks, then slowly tapering as tolerated, usually 10% every couple of weeks. Reducing the dose must take place over a long period of time with slow reductions over many weeks.

Vitamin D is vital – a supplement always in winter in cold climates with little sun, and more so with cortisone. Bisphosphonates and other osteoporosis meds can be considered if indicated. Gastric side effects can be decreased using proton-pump inhibitors.

Managing PMR requires medical and self care. The self care is important. Any load – physical or emotional – that overloads the body can increase inflammation. Gentle exercise and stretching, mindfulness, (look for Palouse mindfulness further down the page), restorative breathing, all help towards moving towards healing.