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  Polymyalgia Rheumatica  
 
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | Recommendations

 

Polymyalgia Rheumatica (PMR) is a clinical syndrome that can be a manifestation of many pathological processes, including rheumatoid arthritis, cancer, and including giant cell arteritis (GCA). PMR usually affects persons older than 50 years, and women are affected twice as often as men. The disorder may have either an acute or insidious onset, producing pain and stiffness in the proximal musculature. Fatigue, depression, weight loss, and fever may also occur. In all likelihood, PMR is a disease of medium-sized and large arteries that is seen in many different entities, GCA and rheumatoid arthritis. The prevalence of PMR may equal that of rheumatoid arthritis in individuals older than 50 years. The two disorders often overlap in clinical presentation, and classification may sometimes present a problem. Symptoms and signs are nonspecific. The differential diagnosis includes rheumatoid arthritis, polymyositis, occult malignant disease, infectious disease, myofascial pain syndromes, and functional abnormalities. In one study, the ESR was strikingly elevated in 99% of patients, hemoglobin levels were decreased in 47%, a2-globulin levels were abnormal in 33%, aspartate aminotransferase levels were elevated in 23%, and alkaline phosphatase levels were increased in 10%. An increased fibrinogen level and normal creatine kinase and aldolase levels are also common.

A dramatic response to corticosteroids (in 24 to 48 hours) helps confirm the diagnosis of PMR, although this finding is not specific. Because PMR and GCA are often parts of the same disease spectrum, therapy must be directed at both symptomatic relief and prevention of catastrophic visual loss. An initial daily regimen of low-dose prednisone (6 to 10mg) or nonsteroidal agents may control morning stiffness and pain. In the absence of ocular symptoms, PMR can be treated with maximal doses of nonsteroidal anti-inflammatory drugs. Prednisone (10 to 15mg daily) will give a more prompt therapeutic response, but the toxicity from long-term use at dosages greater than 7.5 mg/day is high. Usually, low-dosage maintenance can be achieved within weeks. Reassessment is mandatory if ocular or other symptoms develop; in such cases, the steroid dosage must be increased. Some patients require a low dosage of steroids for life; others may be weaned from steroids after 2-4 years.
 

 
 

Signs, symptoms & indicators of Polymyalgia Rheumatica:
 
 
Lab Values - Cells  High ESR or elevated ESR

Counter-indicators:
  Normal ESR or elevated ESR

Symptoms - General

  Fatigue on light exertion

Symptoms - Metabolic

  Having a moderate/having a high/having a slight fever
  Frequent/occasional unexplained fevers

Symptoms - Muscular

  Shoulder pain

Symptoms - Skeletal

  Hip pain
 
 

Conditions that suggest Polymyalgia Rheumatica:
 
 
Mental  Depression
 
 

Risk factors for Polymyalgia Rheumatica:
 
 
Hormones  Low DHEA Level
 Low levels of DHEA have been associated with a wide variety of diseases, including inflammatory, autoimmune diseases such as rheumatoid arthritis and polymyalgia rheumatica.

Infections

  Lyme Disease

Lab Values - Cells

  Having low CD8 count
 Reduced percentages and numbers of CD8 cells have been observed by different authors in untreated patients with active polymyalgia rheumatica (PMR).

Symptoms - Metabolic

  Recent unexplained weight loss
 
 

Polymyalgia Rheumatica suggests the following may be present:
 
 
Autoimmune  Autoimmune Tendency

Inflammation

  Chronic Inflammation
 
 

Recommendations for Polymyalgia Rheumatica:
 
 
Animal-based  Cetyl-myristoleate

Extract

  Devil's Claw (Harpagophytum Procumbens)
 Devil's claw root has an anti-inflammatory property and has been used to treat rheumatic disorders. It can help reduce pain and inflammation associated with polymyalgia. Take 3 extract tablets, or simmer 1 tsp. of devil's claw root in 1 cup of water for fifteen minutes. Drink three times daily for four weeks. Rest for two weeks, and then begin again.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Strongly counter-indicative
May do some good
 
There are two kinds of people: those who say to God, "Thy will be done," and those to whom God says, "All right, then, have it your way." ~C.S. Lewis, The Screwtape Letters, 1943






GLOSSARY

Acute:  An illness or symptom of sudden onset, which generally has a short duration.

Alkaline:  A solution having a pH greater than seven.

Anti-inflammatory:  Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.

Arthritis:  Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.

Autoimmune Disease:  One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.

Cancer:  Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

CD8:  CD8 cells, also called suppressor and cytotoxic T-cells, play a role in fighting viral infections such as HIV. A T lymphocyte that secretes large amounts of gamma-interferon, a lymphokine involved in the body's defense against viruses. CD8 cells prevent the unnecessary formation of antibodies. A healthy adult usually has between 150 and 1,000 CD8 cells per cubic millimeter. In contrast to CD4 cells, people with HIV often have elevated numbers of CD8 cells, the significance of which is not well understood. Lab reports may also list the T-cell ratio, which is the number of CD4 cells divided by the number of CD8 cells. Since the CD4 count is usually lower and the CD8 count higher than normal, the ratio is usually low in people with HIV. A normal T-cell ratio is usually between 1.5 and 2.5 to 1. The expected response to effective combination anti-HIV treatment is an increase in CD4 count, a decrease in CD8 count, and an increase in the T-cell ratio.

DHEA:  Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.

ESR:  Erythrocyte Sedimentaion Rate is a screening test and not considered diagnostic for any particular disorder. It is useful in detecting and monitoring inflammatory conditions, tuberculosis, tissue necrosis (tissue death), connective tissue disease, or an otherwise unsuspected disease in which symptoms are vague or physical findings are minimal.

Hemoglobin:  The oxygen-carrying protein of the blood found in red blood cells.

Insidious:  A symptom or condition of gradual onset or development.

Malignant:  Dangerous. mainly used to describe a cancerous growth -- when used this way, it means the growth is cancerous and predisposed to spreading.

Milligram:  (mg): 1/1,000 of a gram by weight.

Proximal:  Nearer to a point of reference such as an origin, a point of attachment, or the midline of the body.

Rheumatoid Arthritis:  A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).

Steroid:  Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.