How it manifests itself
The disease often begins suddenly: a person goes to bed healthy, but in the morning cannot raise his arms and get up on his own. The pain is felt in the shoulders, neck, upper arms, buttocks and thighs, always on both sides, and increases with movement. The key feature is prolonged morning stiffness, which gradually decreases during the day, but returns after rest. There is no muscle weakness as such: the person is limited by pain, not loss of strength. Sometimes there is swelling of the hands and minor inflammation of the joints.
- Bilateral pain in the shoulders and pelvic girdle
- Morning stiffness for at least half an hour
- Difficulty raising arms and standing up
- Increased pain after rest
- General weakness, loss of appetite, low-grade fever
- Sometimes swelling of the hands and feet
Why is this happening
The exact reason is unknown. It is believed that it is based on inflammation of the membranes of the joints and tendon bursae of the shoulder and pelvic girdle, triggered by a disruption of the immune system in people with a certain predisposition. The role of age-related changes in immunity and previous infections as a trigger factor is discussed. Hereditary transmission is not typical, although a predisposition exists. The disease is closely related to temporal arteritis: these conditions often occur in one person, so the doctor always checks for signs.
- Inflammation of the joint membranes and tendon bursae
- Age-related changes in the immune system
- Possible role of previous infections
- Relationship to temporal arteritis
- No direct hereditary transmission
Survey
There is no specific test for polymyalgia rheumatica, so the diagnosis is made based on a combination of symptoms. ESR and C-reactive protein are almost always elevated, and a general blood test shows moderate anemia. An important part of the examination is to exclude other causes: rheumatoid arthritis, hypothyroidism, myopathies, infections, cancer. For this purpose, rheumatoid factor, antibodies to citrullinated peptide, creatine kinase, thyroid hormones and other studies are prescribed. Ultrasound of the shoulder joints helps to see the characteristic inflammation of the tendon structures.
- ESR and C-reactive protein
- General blood test
- Rheumatoid factor and antibodies to CCP
- Creatine kinase to exclude myopathy
- TSH to rule out hypothyroidism
- Ultrasound of the shoulder joints
- Additional examination if a tumor is suspected
Relationship to temporal arteritis
Polymyalgia rheumatica and temporal arteritis are considered related conditions. Some people with polymyalgia eventually develop inflammation of the large arteries of the head, which can lead to permanent vision loss. Therefore, the doctor must ask about new headaches, scalp tenderness, pain in the masticatory muscles when eating, and visual disturbances. The appearance of these signs requires immediate attention, without waiting for a planned visit: with timely treatment, vision can be preserved.
- New headache in the temple area
- Pain when combing hair
- Jaw pain when chewing
- Double or loss of vision
- Call immediately if these signs appear
Treatment
The basis of treatment is glucocorticoids in small doses. Improvement usually occurs within a few days and is considered an important diagnostic sign. Then the dose is very slowly reduced under the control of well-being and tests; the full course often takes from one to two years, and too rapid a decrease leads to a return of symptoms. Since the treatment is long-term, measures are taken in advance to protect the bones: calcium and vitamin D are monitored, and the risk of osteoporosis is assessed. Possible physical activity and therapeutic exercises are useful to help maintain mobility of the shoulders and hips.
- Low dose glucocorticoids as prescribed by a doctor
- Very gradual dose reduction
- Monitoring ESR and C-reactive protein
- Prevention of osteoporosis, calcium and vitamin D
- Control of blood pressure, sugar and weight during therapy
- Therapeutic gymnastics and feasible activity
- Additional medications for frequent exacerbations