Polymyalgia Rheumatica

Definition

Polymyalgia rheumatica is a syndrome that causes pain and stiffness in the hips and shoulders of people over the age of 50.

Description

Allthough the major characteristics of this condition are just pain and stiffness, there are reasons to believe it is more than just old-fashioned rheumatism. Patients are commonly so afflicted that their muscles atrophy from disuse. A similar complaint of such weakness is also seen in serious muscle diseases. Moreover, some patients develop arthritis or a disease called giant cell arteritis or temporal arteritis.

Causes and symptoms

This condition may arise as often as once in every 2,000 people. Rarely does it affect people under 50 years old. The average age is 70; women are afflicted twice as often as men. Along with the pain and stiffness of larger muscles, headache may add to the discomfort. The scalp is often tender. Pain is usually worse at night. There may be fever and weight loss before the full disease appears. Patients complain that stiffness is worse in the morning and returns if they have been inactive for any period of time, a condition called gelling. Sometimes the stiffness is severe enough that it causes frozen shoulder.

Diagnosis

Symptoms are usually present for over a month by the time patients seek medical attention. A mild anemia is often present. One blood test, called an erythrocyte sedimentation rate, is very high, much more so than in most other diseases. The most important issue in evaluating polymyalgia rheumatica is to check for giant cell arteritis. Giant cell arteritis can lead to blindness if left untreated.

Treatment

Polymyalgia rheumatica responds dramatically to cortisone-like drugs in modest doses. In fact, one part of confirming the diagnosis is to observe the response to this treatment. It may also respond to nonsteroidal anti-inflammatory drugs (NSAIDs). Temporal arteritis is also treated with cortisone, but in higher doses.

Prognosis

The disease often remits after a while, with no further treatment required.

BOOKS

Fauci, Anthony S. "The Vasculitis Syndromes." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.

Griggs, Robert C. "Episodic Muscle Spasms, Cramps, and Weakness." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.

Hellmann, David B. "Arthritis and Musculoskeletal Disorders." In Current Medical Diagnosis and Treatment, 1996. 35th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1995.

Hunder, Gene C. "Giant Cell Arteritis and Polymyalgia Rheumatica." In Testbook of Rheumatology, ed. WilliamN. Kelley, et al. Philadelphia: W. B. Saunders Co., 1997.

Hunder, Gene C. "Polymyalgia Rheumatica and Giant Cell Arteritis." In Cecil Textbook of Medicine, ed. J. Claude Bennett and Fred Plum. Philadelphia: W. B. Saunders Co.,1996.

J. Ricker Polsdorfer, MD

KEY TERMS

Anemia—A condition in which the blood lacks enough red blood cells (hemoglobin).

Atrophy—Wasting away of a body part.

Frozen shoulder—A shoulder that becomes scarred and cannot move.

Giant cell arteritis—Also called temporal arteritis. A condition that causes the inflammation of temporal arteries. It can cause blindness when the inflammation affects the ophthalmic artery.

NSAIDs—Nonsteroidal anti-inflammatory drugs like aspirin, ibuprofen, and naproxen.

Syndrome—A collection of abnormalities that occur often enough to suggest they have a common cause.