Polymyalgia Rheumatica โ€“ Diagnosis and Treatment

Diagnosis

Healthcare professionals use physical exams, lab tests, and imaging to diagnose polymyalgia rheumatica (PMR). They look for symptoms like shoulder pain, morning stiffness, and swelling.

Sometimes, new symptoms appear that point to other conditions like rheumatoid arthritis or giant cell arteritis. Doctors may update the diagnosis as these symptoms develop.

Key Steps in Diagnosis:

Method Purpose
Physical Exam Checks joint movement, swelling, and nervous system health
Blood Tests Measures inflammation markers: sed rate and C-reactive protein
Imaging (Ultrasound, MRI, PET Scan) Finds joint and soft tissue inflammation, rules out other problems

Lab Tests:

  • Erythrocyte Sedimentation Rate (ESR): High ESR often signals inflammation.
  • C-Reactive Protein (CRP): High CRP supports an inflammatory process.

Imaging:

  • Ultrasound detects swelling around joints.
  • MRI and PET scans help when more information is needed.

Doctors may check rheumatoid factor to rule out rheumatoid arthritis. Muscle pain in the hips or shoulders can resemble fibromyalgia, so careful examination is important.

Watching Closely for Signs of Artery Involvement

Doctors watch for warning signs of giant cell arteritis (temporal arteritis), which can occur with PMR. Symptoms include:

  • New or severe headaches
  • Jaw pain or tenderness
  • Blurred vision, double vision, or sudden vision loss
  • Scalp tenderness

Doctors may use ultrasound or biopsy of a temple artery to check for giant cell arteritis. They perform the biopsy with local numbing medicine to confirm if the arteries are affected.

Treatment

Medicines Used in Treatment

Doctors usually start treatment for polymyalgia rheumatica with oral corticosteroids. These medicines reduce pain and stiffness, often within a few days.

Most people take steroids for at least a year. Regular checkups help track progress and identify any problems.

Doctors lower steroid doses step by step to use the smallest amount needed to control symptoms. This process is called tapering.

Corticosteroids can cause side effects like weight gain, osteoporosis, high blood pressure, diabetes, and cataracts. To reduce bone loss, doctors often recommend daily calcium and vitamin D supplements.

Supplement Amount (per day)
Calcium 1,000โ€“1,200 mg
Vitamin D 600โ€“800 IU

If steroids alone do not control symptoms, doctors may add immunosuppressive medications. One option can be started alongside corticosteroids, especially if symptoms relapse or high steroid doses are needed over time.

These medications help suppress the immune response and may reduce the amount of steroids required. In cases where symptoms keep returning, doctors may prescribe a biologic agent that blocks specific inflammatory signals.

This type of medication is usually given as an injection every two weeks and may help manage inflammation while allowing for lower steroid doses.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are rarely used alone for polymyalgia rheumatica (PMR), but they may be added for additional pain relief.

Doctors closely monitor patients for side effects during treatment. They may adjust the plan or add other medications to protect bone health as needed.

Movement and Therapy to Assist Recovery

Doctors may suggest physical therapy when pain or stiffness limits activity. A physical therapist creates a plan to help patients build strength and regain movement.

Therapy focuses on helping people return to their usual activity level. Exercises may include stretching, light strength training, and balance work.

Some people benefit from group exercises or water therapy. The healthcare team chooses the best options for each person.

Regular therapy strengthens the body and lowers the risk of falls and bone loss, which is important for those on long-term steroids.

Physical therapy works with medicine to improve quality of life and keep people active.

Looking After Yourself

Taking care of daily health helps manage polymyalgia rheumatica. Over-the-counter pain relievers like ibuprofen or naproxen sodium can ease aches, but should be used as advised by a healthcare provider.

A balanced meal plan is important. Eating fruits, vegetables, whole grains, lean proteins, and low-fat dairy can reduce steroid side effects. Limiting sodium helps control fluid buildup and supports healthy blood pressure.

Regular physical activity keeps muscles and bones strong. Simple stretches or short walks help, but check with a healthcare professional before starting new activities.

Getting enough sleep and using supportive tools, like grab bars in the shower or carts for groceries, can make daily tasks safer and easier.

Managing Day-to-Day and Emotional Well-being

Taking medicine every day can feel overwhelming. Many people worry about side effects or how the condition could impact their life.

Here are some tips that may help:

  • Reach Out for Support: Joining a local group can help with feelings of loneliness or depression.
  • Talk with Your Healthcare Team: Ask for advice about staying healthy while on corticosteroids.
  • Share Concerns with Family or Friends: Open conversations can help manage stress.

Support from others and practical steps can make daily life easier.

Getting Ready for Your Visit

Steps You Can Take Before Your Appointment

Patients usually see their primary healthcare provider first. They may then see a specialist for joint and muscle problems.

Here are steps to prepare for the appointment:

  • Confirm Instructions: Check if you need to do anything special, like fasting or stopping medications.
  • List Your Symptoms: Write down all symptoms, when they started, and what affects them.
  • Prepare Personal and Family Health Information: Make a summary of important medical events, stresses, recent life changes, and family health history.
  • Note All Medications and Supplements: List every medicine, vitamin, and supplement with dosages.
  • Create a Question List: Write down questions for your healthcare provider.

Some good questions to consider include:

Question Purpose
What could be causing my symptoms? Better understand your condition.
Are there other possible reasons for my discomfort? Rule out other issues.
What tests will I need? Know what to expect next.
Will my condition improve or persist? Set expectations.
What treatments are available? Review possible options.
How do I manage other health issues at the same time? Understand overall care.

Bringing a trusted family member or friend can help you remember important details and instructions.

What Your Healthcare Provider May Ask You

During the appointment, your provider may ask about:

  • Where you feel pain or stiffness.

  • How strong your pain is, on a 1 to 10 scale.

  • When your symptoms are worst, such as in the morning or after rest.

  • How long your stiffness or pain lasts after sleeping or sitting.

  • Whether these symptoms make daily activities difficult.

  • If you have noticed any headaches, jaw pain, or vision changes.

Clear answers help your healthcare provider choose the right next steps and care plan.


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