Polymyalgia Rheumatica

Q:  Could you please explain what polymyalgia rheumatica is? I’ve recently been to the doctor with some new aches and pains that just aren’t going away and wound up with this diagnosis.

A:  Polymyalgia rheumatica (PMR), besides sounding a bit like terminology from a foreign language, is a combination of symptoms usually affecting people over the age of 50. It often presents as aching and stiffness in the upper arms, hips, trunk musculature along with a general feeling of being unwell. It may occur in conjunction with an inflammation of the bloods vessels in the head and neck which sometimes presents as another syndrome called temporal arteritis. Both diseases are relatively common and sadly little is known regarding the cause of either disease.

The onset of PMR may be slow or abrupt. People may experience a sense of illness, fever, and note unexplained weight loss. Joint and muscle aches may be one-sided to begin with but usually spread to the previously unaffected side. Stiffness in the morning and after periods of inactivity is characteristic. Muscle strength is usually unaffected but may be difficult to measure during periods of more intense discomfort.

The diagnosis of PMR is based on the presence of morning stiffness and aching in two of the three most commonly affected areas (neck, shoulders, and hips) for four weeks or longer, and a blood test called "a sedimentation rate" whose results are higher than normal.

Treatment begins with drugs like aspirin or ibuprofen. If they are not effective, oral steroids may be used but carry a greater risk of side effects. PMR tends to run a self-limited course and may resolve after several months to a few years after which most medications can be stopped. PMR itself does not pose a great risk but should provoke investigation regarding the presence of temporal arteritis which, if not diagnosed and treated aggressively, could result in blindness. Make sure you do not understate the degree of your joint discomfort and assume that you have a milder form of arthritis that, in reality, is PMR or another more aggressive form of arthritis. Your doctor can help you in making this distinction and can order the necessary blood tests.

Regardless, it is very important to keep moving and being active for as long as possible and not give in to a sedentary lifestyle with aging. The more you slow down, the harder it will be to keep moving or to restore previous levels of activity.

Dr. Russell Robertson is Associate Dean for Faculty Affairs and Associate Professor of Family and Community Medicine at the Medical College of Wisconsin. His biweekly column of medical advice also appears in the CNI Community Newspapers throughout metropolitan Milwaukee.