DEAR DR. GOTT: My doctor diagnosed me with polymyalgia. I have pain in the back of my head, shoulders and lower back that usually occurs at night and goes away when I get up in the morning. I’m 78 years old, in generally good health with no diabetes, heart or other problems. I go to physical therapy three times a week for my back problem and have traction treatment as well, which seems to be working. Is there any help for me?
DEAR READER: Polymyalgia rheumatica (PMR) is an inflammatory disorder that results in widespread muscle aches, pains and stiffness of the hips, shoulders, thighs, upper arms and neck, fatigue, anemia, malaise and unintentional weight loss. Symptoms experienced are the result of mild inflammation of the joints and surrounding tissue. Stiffness can worsen following periods of inactivity, such as after a night’s sleep or sitting for too long.
The condition is thought to be related to an immune-system arthritic disorder that customarily goes away on its own in a year or two. Initially, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) might control the side effects. Long-term use of NSAIDs can include intestinal bleeding, hypertension, renal insufficiency, fluid retention and more. Beyond that, medication such as corticosteroids and self-help measures can go a long way toward dealing with the discomfort. The downside to long-term steroid use is possible hypertension, osteoporosis, diabetes, weight gain and cataracts.
Self-help includes a nutritious diet rich in fresh fruits and vegetables, lean meats, whole grains, calcium and vitamin D. The latter two recommendations can be satisfied through supplements. The daily recommendation for calcium in people over 50 is 1,200 milligrams per day with 600 to 800 international units (IU) of vitamin D. Exercise, primarily low-impact movement such as swimming, riding a stationary bicycle or walking, will go a long way toward reducing the pain.
Risk factors include age, race, gender and those diagnosed with giant cell arteritis. Older adults, primarily those 70 and older, are affected, and women are twice as likely as men to develop the disorder. No one is immune; however, Caucasians, Scandinavians and people from Northern Europe are most at risk. Finally, giant cell arteritis is a condition in which the temporal arteries and other areas of the body become swollen and inflamed. Almost 50 percent of all people diagnosed with giant cell arteritis are found to have polymyalgia, and up to 20 percent of those with polymyalgia develop giant cell arteritis.
Diagnosis can be made through laboratory testing that may include a rheumatoid factor, sedimentation rate, C-reactive protein, platelet and red-blood-cell counts. The only way to rule out giant cell arteritis is through biopsy from the scalp artery at the temple.
To provide related information, I am sending you copies of my Health Reports “Fibromyalgia” (a related topic) and “Managing Chronic Pain.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.
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