by Sanjay Trivedi, M.D.
I have had patients come to me with Polymyalgia Rheumatica or PMR—a clinical syndrome that usually occurs in middle age (50 years) and up. It is more prevalent in women than men. PMR is characterized by severe pain and stiffness/ache in the neck, shoulders and the pelvic girdle. The onset of pain can be dramatic or insidious in nature.
Patients often come crying with pain from severe stiffness; the muscular pain can be diffused and can sometimes be pinpointed in location. The pain is more common at night. People may have low grade fever, may complain of extreme fatigue, and some may experience weight loss.
Related to this disease is giant cell arteritis—a common condition that is often seen with PMR and can have dangerous consequences. It is a vasculitis—inflammation of the arteries of the head—and can cause headaches and fatigue. These patients have possibility of loss of vision. They have tenderness in the scalp, temporal area, occipital area or the back of head. Some patients have jaw claudication upon chewing.
How to treat Polymyalgia Rheumatica
The patients almost immediately respond to the use of steroids. They have to be closely monitored, however. Steroids are to be continued for a period of months to years depending on the severity of the disease, and then tapered off. More than often the condition does not return after treatment.
What causes Polymyalgia Rheumatica and how can you test for it?
The cause for PMR is not known, it is a form of autoimmune disease. Genetic testing, HLA typing, and certain antigens have been tried with variable results.
There are two main tests on which the diagnosis is based on:
1. ESR – The sedimentation rate will be significantly elevated among people with PMR.
2. Temporal biopsy – The second test normally performed with symptoms suggestive of Temporal Arteritis along with PMR.
What happens if Polymyalgia Rheumatica is not treated?
The pain will surely continue; the pain can get severe enough that a physician will likely treat the patient with anti-inflammatory medication if the condition is not picked up. If there is Temporal Arteritis, there can be blindness due to the inflammation of blood vessels, which is often permanent. Higher doses of steroids may be given.
Call us if you suspect you have Polymyalgia Rheumatica.
Sanjay Trivedi, M.D. received training in general surgery from Seton Hall University in New Jersey, and studied physical medicine and rehabilitation at Kingsbrook Jewish Medical Center and David Minkin Rehabilitation Institute in Brooklyn, New York. Dr. Trivedi’s expertise is in the fields of acute and chronic spinal pain management, acute and chronic pharmaceutical pain management, musculoskeletal and joint pain management, and personal injury rehabilitation and care.