Ask Dr. Gott » PMR

Polymyalgia is a pain

Dr. Gott — Wed, 27 Oct 2010 05:01:57 +0000

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.

Differentiating between fibromyalgia and polymyalgia

Dr. Gott — Thu, 18 Feb 2010 05:01:05 +0000

DEAR DR. GOTT: I recently read in one of your newsletters about fibromyalgia. I have polymyalgia. Could you please explain the difference between the two and what medication I should be using? I would appreciate hearing from you.
DEAR READER: Fibromyalgia is a disorder characterized by widespread pain of muscles and ligaments, coupled with a painful response to even gentle touch. The symptoms may wax and wane and can be vague. Women are more prone to the disorder and typically experience pain throughout the entire body. Men, on the other hand, often report facial pain or discomfort in a specific part of the body. This is often a diagnosis of exclusion, because so many symptoms mimic other disorders, making it difficult for a physician to diagnose. Fibromyalgia cannot be confirmed by X-ray or other specific testing. Weather and physical and emotional stress levels play important roles in day-to-day pain levels and functioning.
Relaxation and stress reduction are both vital components for pain control. Initially, sufferers should speak with a physician for recommendations for appropriate over-the-counter anti-inflammatory drugs. Then these people should set up a plan of regular exercise, reduce consumption of products that contain caffeine and high-fructose corn syrup, and, finally, coordinate a sleep schedule that will provide a refreshing start to each day.
Polymyalgia rheumatica is an inflammatory, arthritic syndrome causing fatigue, weakness, anemia, weight loss, widespread muscle aches, pains and stiffness of the neck, shoulders, upper arms, hips and thighs. It develops over an extended period of time in some people and seemingly overnight in others, lasting a year or two before ceasing. Gender and age increase the risk of developing this condition, as it almost exclusively affects people 70 and older, with women more likely than men to carry the diagnosis.
Normal white blood cells protect the body from invading bacteria and viruses. In the presence of polymyalgia, the body’s white blood cells attack joint linings and cause inflammation. Studies thus far have failed to determine the exact cause of this abnormal immune-system response, but theories lean toward genetic and environmental factors.
Blood testing is a simple method for detection. The two most common tests are a sedimentation rate and rheumatoid factor. A sedimentation rate measures how quickly red blood cells settle in a test tube, with the rate increasing in the presence of inflammation. While this one evaluation can’t create a surefire answer because of rheumatoid arthritis and other disorders, it will help. A rheumatoid factor is a protein made by the immune system present in people with rheumatoid arthritis. It isn’t present, however, in those people with polymyalgia.
Home remedies include proper diet with emphasis on fresh fruits and vegetables, lean meats and fish, whole grains, and supplemental calcium and vitamin D. The current recommendation is 800 IU of vitamin D and 1,200 milligrams of calcium daily. Speak with your physician regarding exercise, a critical component for pain reduction. Consider water aerobics, swimming, riding a stationary bicycle, using an elliptical machine, walking or other low-impact methods to keep limber and prevent weight gain.
To provide related information, I am sending you copies of my Health Reports “Fibromyalgia” 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 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

Wean slowly off Prednisone

Dr. Gott — Thu, 10 Apr 2008 05:00:06 +0000

DEAR DR. GOTT:
I have been taking prednisone 10 mg daily for 14 months for PMR. I cannot take less than 8 mg without a lot of pain in my wrists and hands. I have researched this and discussed my concerns with my rheumatologist who has now put me on methotrexate (4 tablets of 2.5 mg once a week) to try to wean me off the prednisone. Is this the lesser of two evils? I worry about the long-term side effects of both medicines and more importantly, how to cure the PMR. Any suggestions?

DEAR READER:
Polymyalgia rheumatica is an autoimmune disorder that causes muscle pain and stiffness in joint areas. Relief is achieved by reducing inflammation with over-the-counter medications or, in severe cases, with oral steroids as the mainstay of treatment. PMR can be a disabling disorder requiring aggressive therapy in an attempt to reduce the body’s immune response. Unfortunately, the treatment is not without risk.

You apparently have progressed from over-the-counters to prescription medications, and I cannot advise you which drug to take. That decision depends on your response to each medication. Methotrexate is, in my experience, less troublesome than prednisonebut still has its own side effects.

Although some PMR patients suddenly improve after many years, PMR typically is permanent and incurable. Therapy to treat symptoms is extremely effective but must be taken for years.

I believe that you are in good hands; your rheumatologist has made sound decisions thus far. I urge you to stick with the recommendations provided. Periodically review your health issues with him or her and try to get by on the smallest amount of medication that controls your pain.