Polymyalgia rheumatica (PMR), or polymyalgia for short, is a rheumatic inflammatory disease accompanied by severe pain in the neck and shoulders, as well as in the thighs and pelvic area. Predominantly older people suffer from polymyalgia rheumatica.
What is polymyalgia rheumatica?
The muscle pain of polymyalgia rheumatica occurs mainly in the morning and in episodes. The mobility of the body can be massively limited due to the pain. Similar to a flu-like infection, sufferers complain of a poor general condition. In some cases, polymyalgia rheumatica also inflames large blood vessels, especially in the head, such as the temporal artery. If not treated in time, the inflamed arteries may become blocked. If the blood supply to the eye is affected, the sufferer goes blind. In contrast to other muscle diseases, polymyalgia rheumatica does not limit the strength of the muscles. Every year, up to 40,000 people in Germany contract polymyalgia rheumatica, 80% of whom are women. People under the age of 50 are less frequently affected, and those over 60 are particularly severely affected.
Causes
The causes of polymyalgia rheumatica are still largely unknown. However, as in other rheumatic diseases, the immune system is apparently misdirected. Probably age-related malfunctions of the body’s immune cells lead to the production of so-called cytokines (messenger substances consisting of certain proteins), which are directed against the patient’s own body and in this way inflammation is triggered. Polymyalgia rheumatica is therefore a so-called autoimmune disease. The additional inflammation of blood vessels, called vasculitis, may also be due to a malfunctioning immune system, which mistakenly attacks cells of its own body. The inflammation of blood vessels in the head is called arteritis cranialis, which also occurs in half of polymyalgia rheumatica sufferers.
Symptoms, complaints, and signs
The leading 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. In patients with polymyalgia rheumatica, the pain symptoms are most pronounced in the hip muscles, the shoulder muscles and the neck muscles. Characteristically, muscle pain is significantly more severe at night than during the day. Patients frequently further report a sudden onset of morning stiffness that is clearly noticeable. The painful stiffness of the muscles in the pelvic girdle area and/or shoulder area can lead to complete immobility. Some people with polymyalgia rheumatica also complain of a general feeling of illness, such as can occur with flu or a cold. In some patients, anemia develops during the course of the disease. This is accompanied by symptoms such as fatigue, exhaustion, lack of concentration or susceptibility to infections. Anemic patients are also strikingly pale, and the sclera are also pale. Less common complaints include night sweats, loss of appetite and depressive moods. In one fifth of those affected, synovitis also develops. This inflammation of the mucous membranes of the joints (membrana synovialis) also occurs symmetrically and is accompanied by joint pain and restricted movement.
Diagnosis and course
The treating physician will base his or her polymyalgia rheumatica diagnosis on a physical examination of the patient, the medical history, and the results of laboratory testing. Symptoms of polymyalgia rheumatica may include neck, shoulder, upper arm, and pelvic pain, as well as weight loss, sweating, joint pain, and depression. If a polymyalgia rheumatica patient complains of impaired vision or headaches, this may already indicate inflammation of blood vessels in the head. However, the symptoms of polymyalgia rheumatica are very variable. The symptoms of the disease may also be present for a long time before they are confirmed by laboratory tests. Blood tests show the signs of a clear inflammatory change in polymyalgia rheumatica, such as an increased blood sedimentation rate.In contrast, the muscle enzyme CK, which is measured more frequently in other muscle diseases and indicates 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 investigations are performed for differential diagnosis with comparable symptoms (including tumor diseases). If vascular inflammation caused by polymyalgia rheumatica is suspected, a piece of the temporal artery may be removed and examined for inflammation.
Complications
First and foremost, affected individuals suffer from very severe pain due to polymyalgia rheumatica. This pain occurs mainly in the area of the shoulders and the neck and thus reduces the quality of life enormously. Likewise, there is pain in the pelvic area and furthermore also in the thighs. The muscles can also hurt, so that various movements or sporting activities can usually no longer be carried out without further ado. It is not uncommon for the muscles to cramp and for the patient to experience permanent fatigue and exhaustion. Most of those affected also suffer from depression and – associated with this – weight loss. The weight loss has a very negative effect on the patient’s general health and can lead to deficiency symptoms or psychological upsets. Sweating also occurs as an accompanying symptom of polymyalgia rheumatica. Sufferers may suffer from headaches and also from limitations in vision. Polymyalgia rheumatica is treated with the help of medication. In most cases, there are no particular complications. Likewise, a healthy lifestyle also has a positive effect on this disease.
When should one go to the doctor?
Polymyalgia rheumatica should always be treated by a doctor. There is no self-healing in this disease and, in most cases, worsening of symptoms if treatment is not 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 affected person suffers from severe pain in the muscles. The pain can occur in different muscles, but is not associated with any particular activity. They may also occur at night. In some cases, poor concentration or very severe fatigue may also indicate the disease. Patients also frequently suffer from depression or other psychological upsets, which can also be indicative of polymyalgia rheumatica. 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 the affected person is usually not negatively affected.
Treatment and therapy
With the administration of cortisone-containing drugs, the inflammation that can no longer be controlled by the body can be treated effectively and with short-term positive effects. 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 is determined by the severity of the disease symptoms and whether blood vessels are already inflamed. Under no circumstances should an initiated cortisone treatment for polymyalgia rheumatica be abruptly interrupted, as stroke-inducing vasoconstriction may then occur. The goal is for the patient to take no more cortisone than is absolutely necessary to achieve freedom from pain. Side effects can include weight gain and bone loss (osteoporosis). If cortisone treatment for polymyalgia rheumatica is not given in a timely manner, patients may, for example, go blind or suffer a stroke.
Prevention
There are no preventive measures against polymyalgia rheumatica. However, it is important to prevent sequelae by timely cortisone therapy. Side effects cannot be completely ruled out given the substantial amounts of cortisone used in therapy. For the prevention of osteoporosis, the intake of vitamin D and calcium is suitable.If, in individual cases, particularly large doses of cortisone are needed to produce analgesia, suitable preparations may be given as a supplement to suppress the immune system in order to reduce the amount of cortisone otherwise needed to treat polymyalgia rheumatica.
Follow-up
Rheumatoid polymyalgia predominantly affects elderly patients. 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 place a great burden on the patient in everyday life. In addition to treatment, follow-up care is useful to maintain the quality of life of the affected person. The complaints should be alleviated and the disease eliminated. The therapy takes the form of medication. At regular intervals, the family doctor or orthopedist checks the healing progress. If necessary, the dose is varied or other medicine is administered. Painkillers are also recommended to counteract the symptoms. In mild courses, a significant improvement is seen shortly thereafter. Treatment of polymyalgia rheumatica can also extend over a period of up to two years; this is the case with parallel vasculitis. Subsequently, follow-up care sets in. The stable condition after the therapy should be maintained during the aftercare. A healthy diet and avoidance of overly sweet and fatty foods contribute to a favorable development. Even after therapy is completed, the patient should avoid overloading the joints.
What you can do yourself
The options for self-help are relatively limited in polymyalgia rheumatica. The symptoms can be alleviated by taking cortisone, although sufferers must rely on lifelong therapy. Similarly, blood vessels must be checked for inflammation to prevent stroke. Since the use of these drugs is often associated with weight gain, the affected person 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 of polymyalgia rheumatica can be useful, as it leads to an exchange of information, so that certain areas of life can become easier. This exchange can also alleviate psychological complaints. In the case of psychological upsets or depression, discussions with close friends and family are also useful. Since the disease not infrequently leads to very pale skin, the affected person should avoid excessive sunbathing so as not to damage the skin.
