Polymyalgia rheumatica
Encyclopedia
Polymyalgia rheumatica abbreviated as PMR, is a syndrome with pain or stiffness, usually in the neck
, shoulders
, and hips
. The pain can be very sudden, or can occur gradually over a period of time. It may be caused by an inflammatory condition of blood vessels, muscle biopsies
however are normal.
Most PMR sufferers wake up in the morning with pain in their muscles; however, there have been cases in which the patient has developed the pain during the evenings. Patients who have polymyalgia rheumatica may also have temporal arteritis
, a potentially dangerous inflammation of blood vessels in the face. PMR usually goes away within a year or two after treatment.
PMR is usually treated with courses of oral corticosteroid
s.
Studies have shown that about 15% of people who are diagnosed with polymyalgia rheumatica also have temporal arteritis
, and about 50% of people with temporal arteritis
have polymyalgia rheumatica. Some symptoms of temporal arteritis
include severe headaches, scalp tenderness, jaw
or facial soreness, distorted vision or aching in the limbs caused by decreased blood flow, and fatigue.
in genetically susceptible individuals. Several viruses are thought to be linked to polymyalgia rheumatica, including the adenovirus, which causes respiratory infections; the human parvovirus B19
, an infection that affects children; and the human parainfluenza virus. People who have the HLA-DR4
type of human leucocyte antigen appear to have a higher risk of polymyalgia rheumatica.
One blood test
that is usually performed is the erythrocyte sedimentation rate
(ESR) which measures how fast the patient's red blood cells settle in a test tube. The faster the blood cells settle, the higher the ESR value, which means that there is inflammation. Many conditions can cause an elevated ESR, so this test alone is not proof that a person has polymyalgia rheumatica.
Another test that checks the level of C-reactive protein
(CRP) in the blood may also be conducted. CRP is produced by the liver in response to an injury or infection and people with polymyalgia rheumatica usually have high levels. However, like the ESR, this test is also very non-specific.
Polymyalgia rheumatica is sometimes associated with temporal arteritis
, a condition requiring more aggressive therapy. To test for this additional disorder, a biopsy
sample may be taken of the temporal artery.
is the drug of choice for PMR and treatment duration is frequently greater than one year. If the patient does not experience dramatic improvement after three days of 10–20 mg oral prednisone per day, the diagnosis should be reconsidered.
Non Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen
are not useful.
Along with medical treatment, patients are encouraged to exercise and eat healthily. Exercise will help strengthen the weak muscles, and help to prevent weight gain. A healthy diet will help to keep a strong immune system
, and also help build strong muscles and bones.
Neck
The neck is the part of the body, on many terrestrial or secondarily aquatic vertebrates, that distinguishes the head from the torso or trunk. The adjective signifying "of the neck" is cervical .-Boner anatomy: The cervical spine:The cervical portion of the human spine comprises seven boney...
, shoulders
Shoulders
Shoulders is drinking game that involves players competing in a fast paced game attempting to "count" to 21.-Game play:*The game begins with a player slapping his left/right shoulder, this starts the count at 1....
, and hips
Hip (anatomy)
In vertebrate anatomy, hip refer to either an anatomical region or a joint.The hip region is located lateral to the gluteal region , inferior to the iliac crest, and overlying the greater trochanter of the femur, or "thigh bone"...
. The pain can be very sudden, or can occur gradually over a period of time. It may be caused by an inflammatory condition of blood vessels, muscle biopsies
Muscle biopsy
In medicine, a muscle biopsy is a procedure in which a piece of muscle tissue is removed from an organism and examined microscopically. A biopsy needle is usually inserted into a muscle, wherein a small amount of tissue remains. Alternatively, an "open biopsy" can be performed by obtaining the...
however are normal.
Most PMR sufferers wake up in the morning with pain in their muscles; however, there have been cases in which the patient has developed the pain during the evenings. Patients who have polymyalgia rheumatica may also have temporal arteritis
Temporal arteritis
Giant-cell arteritis or Horton disease is an inflammatory disease of blood vessels most commonly involving large and medium arteries of the head...
, a potentially dangerous inflammation of blood vessels in the face. PMR usually goes away within a year or two after treatment.
PMR is usually treated with courses of oral corticosteroid
Corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
s.
Symptoms and signs
There is a wide range of symptoms that indicate if a person has polymyalgia rheumatica. The classic symptoms include:- Pain and stiffness (moderate to severe) in the neckNeckThe neck is the part of the body, on many terrestrial or secondarily aquatic vertebrates, that distinguishes the head from the torso or trunk. The adjective signifying "of the neck" is cervical .-Boner anatomy: The cervical spine:The cervical portion of the human spine comprises seven boney...
, shouldersShouldersShoulders is drinking game that involves players competing in a fast paced game attempting to "count" to 21.-Game play:*The game begins with a player slapping his left/right shoulder, this starts the count at 1....
, and hipsHip (anatomy)In vertebrate anatomy, hip refer to either an anatomical region or a joint.The hip region is located lateral to the gluteal region , inferior to the iliac crest, and overlying the greater trochanter of the femur, or "thigh bone"...
, which inhibits activity, especially in the morning/after sleeping.
- Fatigue and lack of appetite (possibly leading to weight loss) are also indicative of polymyalgia rheumatica.
- AnemiaAnemiaAnemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
- An overall feeling of illness
- Mild fever
Studies have shown that about 15% of people who are diagnosed with polymyalgia rheumatica also have temporal arteritis
Temporal arteritis
Giant-cell arteritis or Horton disease is an inflammatory disease of blood vessels most commonly involving large and medium arteries of the head...
, and about 50% of people with temporal arteritis
Temporal arteritis
Giant-cell arteritis or Horton disease is an inflammatory disease of blood vessels most commonly involving large and medium arteries of the head...
have polymyalgia rheumatica. Some symptoms of temporal arteritis
Temporal arteritis
Giant-cell arteritis or Horton disease is an inflammatory disease of blood vessels most commonly involving large and medium arteries of the head...
include severe headaches, scalp tenderness, jaw
Jaw
The jaw is any opposable articulated structure at the entrance of the mouth, typically used for grasping and manipulating food. The term jaws is also broadly applied to the whole of the structures constituting the vault of the mouth and serving to open and close it and is part of the body plan of...
or facial soreness, distorted vision or aching in the limbs caused by decreased blood flow, and fatigue.
Causes
The cause of PMR is unknown. During this disorder, the white blood cells in the body attack the lining of the joints, causing inflammation. Recent studies have found that inherited factors also play a role in the probability that an individual will develop polymyalgia rheumatica. Several theories have included viral stimulation of the immune systemImmune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
in genetically susceptible individuals. Several viruses are thought to be linked to polymyalgia rheumatica, including the adenovirus, which causes respiratory infections; the human parvovirus B19
Parvovirus B19
The B19 virus, generally referred to as parvovirus B19 or sometimes erythrovirus B19, was the first known human virus in the family of parvoviruses, genus erythrovirus...
, an infection that affects children; and the human parainfluenza virus. People who have the HLA-DR4
HLA-DR4
HLA-DR4 is a HLA-DR serotype that recognizes the DRB1*04 gene products. The DR4 serogroup is large and has a number ofmoderate frequency alleles spread over large regions of the world.-Serology:The serological identification of DR4 is good...
type of human leucocyte antigen appear to have a higher risk of polymyalgia rheumatica.
Diagnosis
There is no specific test to diagnose polymyalgia rheumatica. There are many other diseases which cause inflammation and pain in muscles, but there are a few tests that can help narrow down the cause of the pain. Limitation in shoulder motion, or swelling of the joints in the wrists or hands are noted by the doctor. The doctor will assess the patient's pain, and may perform one of the following tests to determine if polymyalgia rheumatica is indeed the cause of the pain.One blood test
Blood test
A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....
that is usually performed is the erythrocyte sedimentation rate
Erythrocyte sedimentation rate
The erythrocyte sedimentation rate , also called a sedimentation rate or Biernacki Reaction, is the rate at which red blood cells sediment in a period of 1 hour...
(ESR) which measures how fast the patient's red blood cells settle in a test tube. The faster the blood cells settle, the higher the ESR value, which means that there is inflammation. Many conditions can cause an elevated ESR, so this test alone is not proof that a person has polymyalgia rheumatica.
Another test that checks the level of C-reactive protein
C-reactive protein
C-reactive protein is a protein found in the blood, the levels of which rise in response to inflammation...
(CRP) in the blood may also be conducted. CRP is produced by the liver in response to an injury or infection and people with polymyalgia rheumatica usually have high levels. However, like the ESR, this test is also very non-specific.
Polymyalgia rheumatica is sometimes associated with temporal arteritis
Temporal arteritis
Giant-cell arteritis or Horton disease is an inflammatory disease of blood vessels most commonly involving large and medium arteries of the head...
, a condition requiring more aggressive therapy. To test for this additional disorder, a biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
sample may be taken of the temporal artery.
Treatment
PrednisonePrednisone
Prednisone is a synthetic corticosteroid drug that is particularly effective as an immunosuppressant drug. It is used to treat certain inflammatory diseases and some types of cancer, but has significant adverse effects...
is the drug of choice for PMR and treatment duration is frequently greater than one year. If the patient does not experience dramatic improvement after three days of 10–20 mg oral prednisone per day, the diagnosis should be reconsidered.
Non Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen
Ibuprofen
Ibuprofen is a nonsteroidal anti-inflammatory drug used for relief of symptoms of arthritis, fever, as an analgesic , especially where there is an inflammatory component, and dysmenorrhea....
are not useful.
Along with medical treatment, patients are encouraged to exercise and eat healthily. Exercise will help strengthen the weak muscles, and help to prevent weight gain. A healthy diet will help to keep a strong immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
, and also help build strong muscles and bones.
Epidemiology
There are no certain circumstances for which an individual will get polymyalgia rheumatica, but there are a few factors that show a relationship with the disorder.- Usually affects adults over the age of 50
- The average age of a person who has PMR is about 70 years old
- Women are twice as likely to get PMR as men
- The vast majority of people affected are white, specially Scandinavians
- 50% of people with temporal arteritisTemporal arteritisGiant-cell arteritis or Horton disease is an inflammatory disease of blood vessels most commonly involving large and medium arteries of the head...
also have polymyalgia rheumatica