Polymyalgia rheumatic (PMR) is a disease due to inflammation and characterized by aching and prolonged morning stiffness in the shoulder girdle and often in the pelvic girdle and neck. It typically affects older people aged 50 years old and above, and its incidence increases progressively with age, peaking between 70 and 80 years old. PMR usually happens among Caucasians and women are affected two times more than men.
The hallmark manifestations of PMR are shoulder pain which is inflammatory in nature. The inflammatory pain will be worse at night and the pain radiates distally toward the elbows and knees. The disease may affect one side of the shoulder, but it will become bilateral soon. The pain will start quite sudden in some patients but it can also be gradual. Due to the pain, patients will have morning stiffness lasting more than 1 hour. Some patients will have a low-grade fever, depression, fatigue and weight loss. On examination, patients with PMR may show a limited range of activity due to the pain.
PMR will be confused with rheumatoid arthritis, however, there are few criteria that your doctor will identify from the history, examination and investigation in order to confirm the diagnosis. You may be referred to a rheumatologist, a specialist who is concerned regarding musculoskeletal disease and systemic autoimmune conditions if there is doubt about your diagnosis. PMR usually would easily respond to steroid treatment.
However, if PMR is left untreated, it can interfere with mobility. Your daily activities such as dressing, bathing, combing hair, standing up from the couch, getting in and out of a car and even raising the arms over the head can be very difficult. A serious complication of PMR is the development of Giant Cell Arteritis, which causes narrowing of the arteries in the head and the temples. This will result in persistent headaches, scalp tenderness and vision changes and lead to stroke or blindness without any treatment. Another deadly but rare complication of PMR is inflammation of the aorta, the biggest artery which carries blood from the heart to the rest of the body, and this condition will lead to a potential life-threatening aortic aneurysm.
PMR cannot be cured but the symptoms will go away significantly within two weeks of steroid treatment. There is evidence in a study showing that the best steroid dose is 15mg/day as an initial dose. This dose is associated with fewer relapses and shorter steroid requirements and less frequent adverse events.
British Society for Rheumatology suggests that the initial dose of steroid need to be used for 3 weeks, then at 12.5 mg for 3 weeks, then at 10 mg for 4–6 weeks, and subsequently tapered by 1 mg every 4–8 weeks provided no flares occur.
Steroid, as a medication for polymyalgia rheumatic complications or side effects, is many and need to be controlled. They include potential bone loss or osteoporosis, fragility fractures, cataracts, glaucoma, increased risk of contracting infection, stomach bleeding, kidney impairment, developed hypertension, diabetes mellitus, acute myocardial infarction, stroke and peripheral vascular disease. Therefore, you need to abide by all follow appointments and see your doctor to talk about what you experience because not all patients will have the same adverse events.
Your doctor needs to provide prophylaxis for osteoporosis to all patients according to current recommendation since it is the most common side effect of taking steroids. A flu shot, pneumonia vaccine, and/or shingles vaccination also can be considered to offset the risk of infection. You just need to consult your doctor to get the prescribed medication in order to prevent the complications of steroids, which are able to be discontinued after six months to two years of the onset of the clinical symptoms.