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POLYMYALGIA RHEUMATICA - TEMPORAL ARTERITIS

What is Polymyalgia Rheumatica?

Polymyalgia (poly = many : myalgia = muscle pain) rheumatica is a condition of unknown cause. The neck, shoulders, hips and thighs are affected. It can come on suddenly, appearing over a week or two, and sometimes after a ‘flu-like infection. Severe pain and stiffness occurs, initially in the mornings. It may be bad enough to stop you walking, getting out of bed or climbing stairs. On sitting for long periods, the stiffness makes getting up difficult. General unwellness and tiredness is also common, together with some loss of weight. The symptoms may gradually worsen over the weeks before a diagnosis is made. About one person in three with this condition goes on to develop the disorder named temporal arteritis. This is also an inlammation, but affects the medium sized arteries of the body. Commonly the artery over the temple (temporal artery) is affected: red, warm, swollen and tender to touch. Chewing may cause pain. Another frequently involved artery is that which supplies blood to the eye. This leads to blurred vision, or spots or light in front of the eyes : blindness may rarely occur.

How does Polymyalgia Rheumatica occur ?

It is not known what causes polymyalgia rheumatica or temporal arteritis. In temporal arteritis, the swollen tender artery of the scalp can be biopsied. Under the microscope, the walls of the artery are inflamed and invaded with giant cells . Temporal arteritis is therefore sometimes called giant cell arteritis.

Why does Polymyalgia Rheumatica occur ?

It is common in older people, affecting 1 in 50 people over 65 years of age. It is rare before the age of 45. Women are affected more commonly than men. It does not run in families.

Treatment Involved for Polymyalgia Rheumatica

It is sometimes difficult to diagnose polymyalgia rheumatica. A lot of elderly people get stiffness and aches and pains. However, the symptoms of polymyalgia rheumatica are usually much more severe. If temporal arteritis is suspected, a small piece of artery can be removed under local anaesthetic (a biopsy), and examined under a microscope. This can confirm the diagnosis. Steroid treatment offers dramatic relief to the pain and stiffness of polymyalgia rheumatica. Steroids are chemical substances which are normally present in the blood circulation in tiny amounts. Steroid treatment uses much higher dosage than that which occurs naturally in the body. The effect is to reduce any inflammation present. They therefore work very well in polymyalgia rheumatica. Steroids most often prescribed are prednisolone, taken as tablets once a day. The tablet dosage will gradually be reduced every few weeks, depending on how severe the symptoms are and on a blood test, called the ESR (erthrocyte sedimentation rate). The ESR measures the degree of inflammation in the body. Each person responds differently to steroids. The doctor will adjust your tablets to suit your individual needs, trying to reduce them as much as possible. It is important to emphasize that you should never stop the steroid treatment without medical advice. Whilst on tablets, the body forgets how to make its own steroids. You could become very ill if the tablets were suddenly stopped. The doctor will give you a steroid card with current dosage on it. This can be shown to any doctor or hospital to obtain an emergency supply. On average, people have to stay on corticosteroid tablets for 2 to 3 years. Your symptoms of pain and stiffness may also be reduced by adding an anti-inflammatory tablet (a non-steroidal anti-inflammatory drug: NSAID). This may allow the dosage of steroid to be reduced further. In temporal arteritis, steroids must be used in much higher dosage to reduce the inflammation of the artery. The tablets are gradually reduced as in polymyalgia rheumatica.

During Treatment for Polymyalgia Rheumatica

If you are being treated for the milder forms of polymyalgia rheumatica but develop the symptoms of temporal arteritis mentioned above you must let your doctor know immediately. While taking steroids, you will need to see your doctor for a check-up once every month or so. Sometimes the general practitioner will ask the specialized rheumatologist to provide this care. Steroids will make you feel much better, with more energy and good appetite. However, they may cause swollen ankles and fluid may be retained. The face may become more rounded, with more fat on the waistline. The hair and bones may get thinner and skin may bruise more easily. Your doctor may advise tablets to help prevent the thinning of bones (osteoporosis). These are called bisphosphonates, and reduce the likelihood of bone fracture. High blood pressure and diabetes may develop. These changes are related to the dose of tablets and usually go away when the tablets are stopped. It is important to contact your doctor immediately if you develop any new symptoms at all.

After Treatment for Polymyalgia Rheumatica

Steroid treatment may need to be continued for many years. When discontinued, a flare-up can occur, needing a further course of steroids.

If Polymyalgia Rheumatica is Left Untreated

With the condition of polymyalgia rheumatica, you would remain very stiff and suffer with painful muscles, making moving very difficult. Without treatment, you would also have a one in three risk of getting temporal arteritis with the hazard of sudden blindness. Steroid tablets must not be discontinued without medical supervision.