PolyMyalgia Rheumatica - PMR

By J.E. Block M.D., PhD, FACP

While fibromyalgia leads the list of mysterious pain conditions, polymyalgia rheumatica (PMR), is a close second. PMR occurs in older adults who have recent onset of pain in the shoulders, neck, and hips, along with other inflammatory symptoms that can’t be explained by other causes. This disease is considered a variant of cranial arteritis (Temporal arteritis). Like these bad actors, PMR can also cause blindness!

PMR, which commonly causes widespread aching and stiffness, is hard to diagnose because it rarely shows up on physical exam and the laboratory tests are suggestive, but not in themselves diagnostic. In PMR, the aching is located primarily around the shoulders and hips, but other muscles to include the upper arms and legs are involved.

PMR affects more than 700,000 older Americans. If not treated properly, as noted above, it can cause progressive disability and blindness. Although occurring earlier in life, the new criteria for diagnoses of PMR is they meet these six conditions:

• Shoulder (and/or hip) pain on both sides 
• Morning stiffness that lasts at least 45 minutes
• High levels of inflammatory markers. Particularly the ESR  (Erythrocyte Sedimentation Rate, Sed Rate) done on a fresh blood specimen higher than 40 and a C-Reactive Protein (CRP) greater than 15. 
• No swelling in the small joints of the hands and feet, and no positive test for rheumatoid arthritis (RA Factor and anti-CCP) and other auto immune collagen vascular disease such as Lupus (ANA greater than 1:160) 
• A marked improvement within 24 hours of giving 20 mg of prednisone. (This is mine not the American College of Rheumatology criteria)
• Older than 50 years.

Conventionally, we treat PMR by administering low-dose corticosteroid medication. Ten milligrams of Prednisone greatly improves the symptoms in three days.  However, I give 20 mg the first day and if they do not get a brilliant response within 24 hours, the patient does not have PMR. We treat then with low dose prednisone.  This is just 1-2 mg more than the daily dose that keeps the symptoms away. It usually ends up between 6 and 10 mg a day.  The therapy is continued for five to six months then tapered off over two weeks and see if the symptoms return. We also follow the ESR and CRP to predict if the patient is ready to go off steroids.  In the last 20 years, I have given the Rheumatoid Arthritis drug MethylTreXate (MTX) as a steroid sparing medicine.  It is given by self-injection weekly to spare the liver of its main side effect of elevation of liver enzymes. Other Rheumatoid Biologics are also used such as Remicaid, Humera, and Embrel, but they are extremely expensive and not yet FDA approved for PMR.

Although natural remedies for fibromyalgia and rheumatoid arthritis may also work for PMR, I do not recommend them alone since they are neither curative nor shown to prevent blindness. These include 5-HTP, capsaicin, SAMe, Boswellia, Cats Claw, acupuncture, massage, fish oil, and bromelain. 

Source : 

http://docblock.com/polymyalgia-rheumaticapmr 

http://polymyalgiarheumaticasymptoms.org

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