Polymyalgia rheumatica

Infobox_Disease
Name = Polymyalgia rheumatica


Caption = In polmyalgia rheumatica (PMR), pain is usually located in the shoulders and hips.
DiseasesDB =
ICD10 = ICD10|M|35|3|m|30
ICD9 = ICD9|725
ICDO =
OMIM =
MedlinePlus = 000415
eMedicineSubj = emerg
eMedicineTopic = 473
MeshID = D011111

Polymyalgia rheumatica (meaning "pain in many muscles" in Greek), abbreviated as PMR, is an inflammatory condition of the muscles, which causes 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.

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.cite web |author=Gelfand JL |title=Polymyalgia Rheumatica and Temporal Arteritis |url=http://arthritis.webmd.com/polymyalgia-rheumatica-temporal-arteritis |date=November 18, 2007 |publisher=WebMD |accessdate=2008-06-10] Patients who have polymyalgia rheumatica may also have temporal arteritis, which causes inflammation that damages large and medium size arteries. PMR usually goes away within a year or two after treatment.cite web |author= |title=Polymyalgia Rheumatica |url=http://www.mayoclinic.com/health/polymyalgia-rheumatica/DS00441/DSECTION=1 |date=May 17, 2008 |publisher=MayoClinic |accessdate=2008-06-10]

ymptoms and signs

There is a wide range of symptoms that indicate if a person has polymyalgia rheumatica. The symptoms include pain and stiffness in the muscles, usually in the neck, shoulders, and hips. The pain is moderate to severe, and may inhibit the activity of the person. These symptoms usually occur in the morning, or after sleeping. Fatigue and lack of appetite are also indicative of polymyalgia rheumatica. Lack of appetite could lead to unintentional weight loss. Anemia is another sign of polymyalgia rheumatica. An overall feeling of illness and a slight fever are commonly seen.

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.

Causes

The cause of this disorder is unknown; however, studies have shown that 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 become sick with polymyalgia rheumatica. Several theories have included viral stimulation of the immune system in genetically susceptible individuals.cite web |author=Shiel Jr WC |title=Polymyalgia Rheumatica (PMR) & Giant Cell Arteritis (Temporal Arteritis) |url=http://www.medicinenet.com/polymyalgia_rheumatica/article.htm |date=3/13/2008 |publisher=MedicineNet |accessdate=2008-06-10] 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.

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 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.

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.

Treatment

Anti-inflammatory medicine such as aspirin or ibuprofen are typically prescribed to treat mild cases of polymyalgia rheumatica. For more serious cases, with extreme pain and discomfort, glucocorticoid steroids are prescribed to patients. Prednisolone, or its prodrug Prednisone, are the steroids typical used to treat PMR. Usually relatively low dosages are prescribed and results are usually seen within a few days.cite web |author=Docken WP |title=Polymyalgia rheumatica |url=http://www.rheumatology.org/public/factsheets/pmr_new2.asp |date=June 2006 |publisher=American College of Rheumatology |accessdate=2008-06-10] Once the patient clinically improves and the ESR returns to normal, the strength of the steroid dose may be reduced to maintain control of the condition while minimising the long term side of steroids such as hypertension, weight gain, diabetes, osteoporosis and immune suppression.

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.

Treatment lasts as long as needed; however, it normally takes patients several years to be reduced off of the steroids. The symptoms may come back when the dosage is lowered.

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
*50% of people with temporal arteritis also have polymyalgia rheumatica

References

External links

* [http://www.mayoclinic.com/health/polymyalgia-rheumatica/DS00441 Mayo Clinic PMR factsheets]
* [http://www.rheumatology.org/public/factsheets/polymyalgiarheumatica.asp American College of Rheumatology's PMR factsheet]