Polymyalgia rheumatica (PMR), or polymyalgia for short, is a rheumatic inflammatory disease that is accompanied by severe pain in the neck and shoulders as well as in the thighs and pelvic area. Mainly older people develop polymyalgia rheumatica.
What is polymyalgia rheumatica?
The muscle pain associated with polymyalgia rheumatica occurs mainly in the morning and in phases. The mobility of the body can be massively restricted due to pain. Similar to a flu infection, the sick complain about a poor general condition. See howsmb for Human Immunodeficiency Virus Definition and Meaning.
In some cases, polymyalgia rheumatica also inflames large blood vessels, especially in the head, e.g. B. the temporal artery. If not treated in time, the inflamed veins can become blocked. If the blood supply to the eye is affected, the patient goes blind. In contrast to other muscle diseases, polymyalgia rheumatica does not limit the strength of the muscles.
Up to 40,000 people are newly diagnosed with polymyalgia rheumatica in Germany every year, 80% of them women. People under the age of 50 are less likely to be affected, while those over 60 are particularly badly affected.
The causes of polymyalgia rheumatica are still largely unexplained. However, as with other rheumatic diseases, the immune system is apparently misdirected.
It is likely that age-related malfunctions in the body’s own immune cells lead to the production of so-called cytokines (transmitters consisting of certain proteins) that attack the body and trigger inflammation in this way. Polymyalgia rheumatica is therefore a so-called autoimmune disease.
The additional inflammation of blood vessels, which is called vasculitis, may also be due to a malfunctioning immune system, which mistakenly attacks cells in the body. The inflammation of blood vessels in the head is called arteritis cranialis, which also occurs in half of polymyalgia rheumatica sufferers.
Symptoms, Ailments & Signs
The main symptom of the autoimmune disease polymyalgia rheumatica is pain in the muscles of the extremities. This pain always occurs symmetrically, so that both sides are always affected. The pain symptoms in patients with polymyalgia rheumatica are particularly evident in the hip, shoulder and neck muscles. Characteristically, the muscle pain is much worse at night than during the day.
Patients also often report a sudden onset of clearly noticeable morning stiffness. The painful stiffness of the muscles in the pelvic girdle area and/or in the shoulder area can lead to complete inability to move. Some people with polymyalgia rheumatica also complain of a general feeling of illness, such as can occur with the flu or a cold, for example.
Some patients develop anemia as the disease progresses. This is accompanied by symptoms such as tiredness, exhaustion, lack of concentration or susceptibility to infections. Anemic patients are also noticeably pale, and the sclera of the eyes are also pale.
Less common complaints include night sweats, loss of appetite, and depressed mood. A fifth of those affected also develop synovitis. This inflammation of the synovial membrane (membrana synovialis) also occurs symmetrically and is associated with joint pain and restricted mobility.
Diagnosis & History
The attending physician will base his polymyalgia rheumatica diagnosis on a physical examination of the patient, the medical history and the results of the laboratory tests.
In addition to neck, shoulder, upper arm and pelvic pain, symptoms of polymyalgia rheumatica can also include weight loss, sweating, joint pain and depression. If a polymyalgia rheumatica patient complains of impaired vision or headaches, this may already indicate an inflammation of blood vessels in the head.
However, the symptoms of polymyalgia rheumatica are very changeable. The symptoms of the disease can also be present for a long time before they are confirmed by laboratory tests. Blood tests show signs of a clear inflammatory change in polymyalgia rheumatica, e.g. B. an increased blood sedimentation rate.
On the other hand, the muscle enzyme CK, which can be measured to a greater extent in other muscle diseases and indicates the destruction of muscle tissue, is not conspicuous in polymyalgia rheumatica.
A clear indication of the presence of polymyalgia rheumatica is to eliminate the symptoms of the disease in the short term by administering cortisone. However, if this is not achieved, further examinations are carried out for differential diagnostics with comparable symptoms (including tumor diseases). If there is a suspicion of vascular inflammation caused by polymyalgia rheumatica, a piece of the temporal artery can be removed and examined for inflammation.
First and foremost, those affected suffer from very severe pain due to polymyalgia rheumatica. This pain occurs mainly in the shoulder and neck area and thus reduces the quality of life enormously. There is also pain in the pelvic area and also in the thighs. The muscles can also hurt, so that various movements or sporting activities can usually no longer be carried out easily.
The muscles often cramp and the patient becomes permanently tired and exhausted. Most of those affected also suffer from depression and – associated with it – weight loss. The weight loss has a very negative effect on the general health of the patient and can lead to deficiency symptoms or psychological upsets.
Sweating also occurs as a side effect of polymyalgia rheumatica. Those affected may suffer from headaches and visual impairments. Polymyalgia rheumatica is treated with medication. Usually there are no special complications. A healthy lifestyle also has a positive effect on this disease.
When should you go to the doctor?
Polymyalgia rheumatica should always be treated by a doctor. This disease does not heal itself and, in most cases, the symptoms worsen if no treatment is initiated. Early treatment and diagnosis always have a positive effect on the course of the disease. A doctor should be consulted for polymyalgia rheumatica if the person affected suffers from severe pain in the muscles. The pain can occur in different muscles, but is not associated with a specific activity. They can also appear at night. In some cases, a lack of concentration or a very strong tiredness can indicate the disease. Patients also often suffer from depression or other mental disorders,
The disease can be treated by an orthopedist or by a general practitioner. However, a complete cure is not always possible. The life expectancy of those affected is usually not negatively affected.
Treatment & Therapy
With the administration of drugs containing cortisone, the inflammation that the body can no longer control can be treated effectively and with a short-term positive effect.
The cortisone is taken as a tablet or injected. As a rule, the daily cortisone treatment begins with a high dose, which is then gradually reduced over a period of weeks or months. The low dosage achieved is then maintained for a period of one to two years. The dose to be taken depends on the severity of the symptoms of the disease and whether blood vessels are already inflamed.
Under no circumstances should a cortisone treatment for polymyalgia rheumatica be abruptly interrupted, since stroke -triggering vascular constrictions can then occur. The aim is that the patient does not take in more cortisone than he absolutely needs to achieve freedom from pain.
Weight gain and bone loss (osteoporosis) can occur as side effects . If cortisone treatment for polymyalgia rheumatica is not carried out in time, the patients can e.g. B. go blind or suffer a stroke.
There are no preventive measures against polymyalgia rheumatica. However, it is important to avoid consequential damage through timely cortisone therapy. In view of the considerable amounts of cortisone used in the therapy, side effects cannot be completely ruled out. Taking vitamin D and calcium is good for preventing osteoporosis.
If, in individual cases, particularly large doses of cortisone are required to produce freedom from pain, suitable preparations can also be administered to suppress the immune system in order to reduce the amount of cortisone otherwise required to treat polymyalgia rheumatica.
Older patients are predominantly affected by rheumatic polymyalgia. Most become ill at an average age of 60 years. Below this age limit, polymyalgia rheumatica rarely occurs. The disease is accompanied by pain in the joints and can be very stressful for the patient in everyday life. In addition to the treatment, follow-up care is useful in order to maintain the patient’s quality of life. The symptoms should be alleviated and the disease eliminated.
Therapy is in the form of medication. The family doctor or orthopedist checks the healing progress at regular intervals. If necessary, the dose is varied or other medicines are given. It is also advisable to give painkillers to relieve the symptoms. In the case of mild courses, a significant improvement sets in shortly afterwards.
The treatment of polymyalgia rheumatica can also extend over a period of up to two years, this is the case with parallel vasculitis. After that, follow-up care begins. The stable condition after the therapy should be maintained as part of the follow-up care. A healthy diet and avoiding too sweet and greasy foods contribute to a favorable development. Even after the end of the therapy, the patient should avoid overloading the joints.
You can do that yourself
The possibilities for self-help are relatively limited in the case of polymyalgia rheumatica. The symptoms can be alleviated by taking cortisone, whereby those affected are dependent on lifelong therapy. Likewise, the blood vessels must be checked for inflammation to avoid a stroke.
Since taking these drugs is often associated with weight gain, the person affected is dependent on a healthy diet and an active lifestyle. Calcium and vitamin D have a very positive effect on the symptoms of the disease. Direct prevention of polymyalgia rheumatica is usually not possible.
Furthermore, contact with other patients with polymyalgia rheumatica can also be useful, since this leads to an exchange of information, so that certain areas of life can become easier. This exchange can also alleviate psychological ailments. In the case of psychological upsets or depression, discussions with close friends and family are also suitable. Since the disease often leads to very pale skin, the affected person should avoid excessive sunbathing in order not to damage the skin.