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    Diseases
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    Polymyalgia Rheumatica

    Overview

    Polymyalgia Rheumatica (PMR) is an inflammatory disorder that causes muscle pain and stiffness, primarily affecting the shoulders, neck, upper arms, hips, and thighs. It typically occurs in adults over the age of 50 and is more common in women than men. PMR is closely linked to inflammation of the blood vessels and is sometimes associated with a condition called giant cell arteritis (GCA). The condition often develops suddenly and can cause significant discomfort but usually responds well to treatment with corticosteroids. Early recognition and treatment are crucial to improving quality of life and preventing complications.

    Causes

    The exact cause of polymyalgia rheumatica is not fully understood, but several factors may contribute to its development:

    • Autoimmune Factors: PMR is believed to be an autoimmune disorder, where the immune system mistakenly attacks the body’s tissues, causing inflammation.
    • Genetics: A genetic predisposition may play a role, as PMR tends to run in families, and certain genetic markers are more common in affected individuals.
    • Environmental Triggers: Viral infections have been suggested as possible triggers, although no specific virus has been definitively linked to PMR.
    • Age and Gender: PMR almost exclusively affects people over 50, with the highest incidence in individuals between 70 and 80 years old. It is more common in women than men.

    Symptoms

    Polymyalgia rheumatica typically presents with a combination of the following symptoms:

    • Muscle Stiffness: Stiffness is most pronounced in the morning or after periods of inactivity, often lasting more than 30 minutes.
    • Muscle Pain: Aching pain affects both sides of the body, especially around the shoulders, neck, hips, and thighs.
    • Fatigue: Many patients experience general tiredness and a lack of energy.
    • Low-Grade Fever: A mild fever can accompany the muscle pain and stiffness.
    • Weight Loss: Unintentional weight loss may occur in some cases.
    • Limited Range of Motion: Daily tasks like dressing, combing hair, or getting out of bed may become difficult due to pain and stiffness.
    • Joint Pain: Some individuals may experience joint discomfort, particularly in the wrists or knees.

    Diagnosis

    Diagnosis of polymyalgia rheumatica is primarily clinical but supported by laboratory tests and imaging studies to exclude other conditions:

    • Medical History and Physical Exam: Evaluation of characteristic symptoms and exclusion of other causes of muscle pain and stiffness.
    • Inflammatory Markers: Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are typical indicators of inflammation in PMR.
    • Blood Tests: Additional tests may rule out other conditions like rheumatoid arthritis, lupus, or thyroid disorders.
    • Response to Steroids: A dramatic improvement in symptoms after a low dose of corticosteroids often supports the diagnosis of PMR.
    • Imaging Studies: Ultrasound or MRI may reveal inflammation in the joints and surrounding tissues, helping to confirm the diagnosis and rule out other diseases.

    Treatment

    Treatment for polymyalgia rheumatica focuses on reducing inflammation, relieving symptoms, and maintaining quality of life:

    Corticosteroids

    • Prednisone: Low doses of prednisone are the mainstay treatment, often resulting in rapid symptom relief within a few days.
    • Gradual Tapering: The dose is slowly reduced over time, often lasting one to two years, to prevent relapse.

    Additional Therapies

    • Calcium and Vitamin D Supplements: Recommended to prevent osteoporosis, a side effect of long-term steroid use.
    • Bone Protection Medications: In some cases, bisphosphonates may be prescribed to further protect bone health.
    • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Occasionally used for mild cases or as additional pain relief.

    Lifestyle Modifications

    • Regular Exercise: Light physical activity and stretching help maintain mobility and reduce stiffness.
    • Healthy Diet: A balanced diet rich in calcium and vitamin D supports bone health during treatment.
    • Regular Monitoring: Frequent follow-up visits are necessary to adjust steroid doses and monitor for side effects.

    Prognosis

    The prognosis for polymyalgia rheumatica is generally very good, especially with early diagnosis and proper treatment:

    • Excellent Symptom Control: Most individuals experience rapid relief of symptoms within days of starting corticosteroids.
    • Long-Term Management: Although treatment may continue for 1-2 years, most people can taper off medication successfully.
    • Relapse Risk: Some patients experience flare-ups, especially during dose reduction, but these are usually manageable.
    • Association with Giant Cell Arteritis (GCA): Up to 15-20% of patients may develop GCA, which requires prompt treatment to avoid serious complications like vision loss.

    With appropriate treatment and follow-up care, individuals with polymyalgia rheumatica can lead normal, active lives with minimal long-term complications.