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Are you struggling with persistent pain and stiffness in your shoulders, neck or hips beyond the usual aches and pains of aging? Polymyalgia rheumatica, a common inflammatory rheumatic disease affecting older adults, may be the culprit.
Understanding PMR’s key symptoms, diagnostic process and available treatment options is crucial to manage your condition effectively and improve your quality of life.
What Is Polymyalgia Rheumatica?
Polymyalgia rheumatica is an inflammatory disorder characterized by muscle pain and stiffness in the shoulders and hip joints that primarily affects older adults.
“This is not a muscle disease,” explains Dr. Keith Reich, a board-certified rheumatologist based in Indiana. “It’s a disease of the joints and the tendons attaching around the joints.”
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Risk Factors for Polymyalgia Rheumatica
Although the exact cause of PMR is unknown, there are several risk factors associated with the condition:
— Age. PMR typically occurs in people after age 50 and becomes more common in their 70s and 80s.
— Gender. Women are two to three times more likely to develop PMR than men.
— Ethnic and/or racial background. The disease is much more common among white adults from northern European or Scandinavian countries. It’s much less common in Black or Asian populations.
— Environmental factors. Some studies have suggested a seasonal variance with certain infections or viruses. However, because the exact triggers are not well understood, further research is needed.
Polymyalgia rheumatica and giant cell arteritis
PMR is closely linked with an autoimmune disease called giant cell arteritis (GCA), which is an inflammatory condition affecting the arteries. They’re related conditions that often occur together.
“We don’t know why some people develop one, some the other or some both together,” Reich says.
PMR can occur before, alongside or after GCA. Although PMR is two to three times more common than GCA, it occurs in about half of all patients diagnosed with GCA.
GCA is a more serious condition and can lead to severe complications if left untreated. Like PMR, it’s also treated with corticosteroids, but requires much higher doses to prevent serious complications and manage the inflammation.
If not promptly and effectively treated, risks of GCA can include:
— Temporary or permanent vision loss
— Stroke
— Aneurysms
— Cognitive effects
— Death
While PMR can be debilitating and may lead to pain or falls that could result in injury, it doesn’t directly cause serious complications like stroke or fatalities.
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Polymyalgia Rheumatica Symptoms
Common symptoms of PMR include:
— Joint aches and pain, particularly in the shoulders, neck and hips
— Limited range of motion in affected areas
— Weakness
— Fatigue or general malaise
— Low-grade fever
— Loss of appetite or unintended weight loss
“The stiffness is key,” Reich says. “If someone does not have stiffness, this is not the right disease.”
Symptoms can come on quickly and significantly impact daily life, typically worsening in the morning or during periods of inactivity. Physical movement may help ease your symptoms.
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Diagnosis of Polymyalgia Rheumatica
The condition’s vague symptoms — including general stiffness and pain in the shoulders, neck and hips — overlap with several other disorders, such as rheumatoid arthritis and fibromyalgia, which can make diagnosis challenging.
“In rheumatology, we often live in shades of gray as opposed to many other specialties,” Reich says. “Many of the symptoms are relatively nonspecific.”
If you’re experiencing severe pain or a level of discomfort that’s causing difficulty performing daily activities, visit your primary care physician or a rheumatologist for further evaluation.
Diagnosing polymyalgia rheumatica involves a combination of clinical evaluation, patient history and diagnostic tests:
1. Clinical evaluation and medical history
Taking the patient’s age into account is important because the disease typically doesn’t occur below age 50. Your doctor will conduct a symptom assessment, gathering a detailed description of your discomfort or pain, including the onset and duration of symptoms.
Your doctor may also perform a physical exam to assess your range of motion, tenderness and swelling in affected joints.
2. Blood tests
Certain blood tests can show inflammation. The most commonly used tests for diagnosing PMR include:
— Erythrocyte sedimentation rate (ESR) test. This is performed to determine if your red blood cells are sinking faster than normal which points to inflammation.
— C-reactive protein (CRP) test. This measures your CRP levels, which is a protein made by the liver, and points to an inflammatory condition if your levels are high.
“Those should be elevated. If not, we often are looking for another diagnosis,” Reich says.
However, elevated ESR and CRP levels can be seen in various conditions other than PMR, so results alone don’t point to a diagnosis.
3. Imaging tests
Depending on individual symptoms, your doctor may also order an MRI, PET, CT or ultrasound to rule out other conditions or assess the extent of inflammation.
4. Ruling out other diseases
Your symptoms and the results of blood tests can help rule out other conditions that may have symptoms in common, such as:
— Rheumatoid arthritis
— Hypothyroidism, a condition characterized by an underactive thyroid
5. Treatment and monitoring
Because there’s no definitive test that can definitively diagnose PMR, a patient’s response to treatment is considered an important part of diagnosing the disease.
If a patient has PMR, they usually respond very promptly to treatment. However, if they don’t, doctors will look for another diagnosis.
Therefore, it’s important to closely monitor patients after beginning a treatment regimen and adjust accordingly.
Polymyalgia Rheumatica Treatment
Oral corticosteroids are anti-inflammatory medications that are the mainstay treatment for PMR.
Corticosteroids, like prednisone, are highly effective, and patients often experience a significant improvement in their symptoms within days. However, they are a “double-edged sword,” Reich says, as there are risks associated with corticosteroids, especially with long-term use.
Side effects or increased risks associated with prolonged steroid use include:
— Increased appetite and weight gain
— Sleeping problems
— Diabetes
— Risk of infection
— Vision problems, such as cataracts and glaucoma
Your doctor will closely monitor your symptoms, conduct follow-up blood tests and gradually taper your corticosteroid dosage based on treatment response and side effects. Even once symptoms resolve, you may stay on a low-dose maintenance steroid for six months to a year, as it is possible to get PMR again.
“For most people, it’s one and done,” Reich says. “But it can reoccur.”
If you’re not a candidate for corticosteroids — such as due to a preexisting condition — or you’re not responding to treatment, there are other medication options available, including a Food and Drug Administration-approved self-injectable drug called sarilumab (Kevzara).
However, whether or not your health insurance covers the drug depends on your specific plan. Original Medicare, which consists of Part A (hospital insurance) and Part B (medical insurance), generally doesn’t cover self-administered injectables or injectables that are not administered during a doctor visit, which includes Kevzara.
For those who opt in to Medicare Part D (drug coverage) or have a Medicare Advantage plan, your plan may cover self-injectable drugs, but it may come with high out-of-pocket costs.
It’s important to check with your health insurer for specific details about what coverage applies.
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What Is Polymyalgia Rheumatica? originally appeared on usnews.com
