Friday, January 25, 2008


Quick onset of pain could mean common arthritic condition

If you develop aching and stiffness around the upper arms, neck, lower back and thighs, the cause might be polymyalgia rheumatica (PMR), which rheumatologists commonly diagnose in patients over the age of 50.

Thee symptoms tend to develop quickly, over a period of few days or week and occasionally overnight. Involvement of the upper arms, and difficulty raising them above the shoulders is common. Aching and stiffness are worse in the morning, and tend to improve gradually as the day goes by. Occasionally this aching occurs in joints such as those of the hand and feet.

Causes unknown
The cause is unknown. “Myalgia” is a term for “muscle pain,” but tests for muscle damage are not elevated. We now know that PMR is an arthritis that has a tendency to involve the shoulder and hip joints and the bursae around these joints. The pain in the arms and things comes from the nearby shoulder and hip joints.

Who gets PMR?
It occurs in older adults, and rarely in people younger than 50. Average age is greater than 60. Women are affected somewhat more than men, and the disease is more frequent in whites than non-whites.
PMR is not unusual – it is diagnosed more frequently than Rheumatoid arthritis in older adults.

Diagnosis and treatment
Blood tests that detect inflammation are helpful. These include ESR (sedimentation rate) and C-reactive protein tests. Both tests are elevated in most patients, but a small proportion of patients can have these tests normal.
When a physician strongly suspects PMR, a trial of Prednisone is given daily. If patients have PMR they have a response in a matter of few day s– and the response is dramatic. Ibuprofen, naproxen and Tylenol are only minimally helpful at best.
The Prednisone dose is gradually reduced over a period of 12- 18 months. The goal is to find the lowest helpful dose that keeps the patients comfortable. Clinicians monitor lab results on a regular basis while tapering the prednisone. Also, side-effects of chronic prednisone therapy are monitored, like increasing blood sugar, weight gain and osteoporosis.

A cautionary note
PMR can be associated with a more serious condition, giant cell arteritis (GCA). We advise all our patients with PMR to look for temporal headache, change in vision, and jaw pain. If any of this happens they are told to report to us right away or if they are having visual symptoms they should go to the Emergency Department to prevent blindness.

Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center, located at the Backus Outpatient Care Center in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Varma and all of the Healthy Living columnists at

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