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.

I have sleep apnea. During my sleep test, they discovered my restless legs syndrome. I now take Mirapex and Clonazepam and that is controlled.

Would massage therapy be helpful in reducing my pain and stiffness? Also, I’d like to know if there’s a support group I could attend in my area with people who have these same symptoms.

DEAR READER:
Polymyalgia rheumatica (PMR) is an autoimmune disorder that causes stiffness and pain in the muscles of the hips, neck and shoulders. The disorder occurs most often in women and in the elderly.

If you are willing to try prednisone again, I suggest you first discuss the dosage you were on with your primary care physician or rheumatologist. Cut the dose and perhaps you will benefit from the modification.

Massage therapy will certainly make you feel better and is worth a try. I suggest you find a therapist who has worked with other PMR or fibromylagia sufferers. You may wish to experiment with acupuncture. Be sure to find a certified individual who practices in a clean office and uses sterilized needles. If you don’t wish to be stuck with pins, you may prefer acupressure. This is similar to acupuncture but doesn’t involve needles, rather the therapist uses his or her hands to apply pressure to certain areas of the body believed to relieve pain, increase circulation and more.

Relief may be found with acetaminophen (Tylenol), ibuprofen (Advil, Motrin) or naproxen sodium (Aleve) that reduce swelling and pain. Unfortunately, most individuals do not respond well to this therapy and require prescription pain relievers such as Lyrica and steroids such as prednisone.

Modify your diet to include garlic, nuts, grapes, curry, cherries, omega 3’s, and green tea. All these items have been purported to relieve some forms of arthritis pain.

Formulate a plan of exercise. You might even ask your physician for an out-patient referral to a local physical therapy group at your nearest hospital or sports medicine center. By obtaining professional assistance, you will not overdo, but will be able to incorporate what will work best for the degree of PMR you have. Should you have access to a swimming pool, fitness center or YMCA in your area, water therapy is an excellent indulgence for individuals with arthritis pain. Water aerobics provide gentle range of motion exercise and provide relief for several days following therapy. You might consider a whirlpool mat in the bottom of your own bath tub where you can do limited exercise right at home.

Barring unknown medical problems, the above suggestions should work toward relieving the pain and suffering you are experiencing.

Because I am not familiar with the community in which you live, I recommend you contact the Arthritis Foundation toll free at 1-800-283-7800 or go online to www.arthritis.org to determine the nearest support group in your area.

To give you related information, I am sending you a copy of my Health Report “Managing Chronic Pain”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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.