Ask the Doctors

Dear Doctor: Please inform your readers about polymyalgia rheumatica. I thought I was experiencing arthritis, until my doctor informed me otherwise.

Dear Reader: Polymyalgia rheumatica is a common disorder that generally occurs in adults over the age of 50, with peak incidence occurring between the ages of 70 to 80. PMR causes stiffness and aching in both shoulders and both sides of the neck; it also affects the hips and lower back. The symptoms are worse first thing in the morning, and ease over the course of the day.

The condition is two to three times more common in women than in men and is also more prevalent among people of northern European ancestry. In fact, among those over 50 in one Minnesota county, the prevalence of PMR is 1 in 140 people. The rate appears to be lower in parts of the country with greater African-, Asian- and Latin-American populations.

The causes of PMR are unknown. It's possible that an environmental factor leads to the production of inflammatory molecules. Note, however, that although the word polymyalgia implies muscle inflammation, no muscle damage has been linked to the condition. What does appear to happen is inflammation of the tendons, bursa and joints in the hips and shoulders.

This inflammation leads to severe stiffness and pain. The stiffness often occurs suddenly, causing significant movement problems. An affected person can have difficulty getting out of a chair or putting on socks or a shirt. Half the time, the symptoms occur beyond the hips and shoulders, such as the wrists, hands and the knees. Often, patients with PMR also experience fatigue, weight loss and low-grade fever.

PMR causes a decreased range of motion in the shoulders and hips and sometimes swelling at the wrist and hands. A doctor's diagnosis is solidified with blood tests that show elevations in the inflammatory markers, Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Moreover, people with PMR may have mild anemia, which may be a reason for the fatigue.

Treatment consists of medication to decrease the inflammation, often with a low dose of the steroid prednisone. In fact, a significant rapid improvement of symptoms with a 15- to 20-milligram dose of prednisone helps to differentiate PMR from other disorders.

Because long-term use of oral steroids like prednisone can increase the risk of osteoporosis, high blood pressure and elevations of blood sugar, the medication should be tapered off after a while. This must be done slowly, however, so that the symptoms of PMR don't return. In total, oral steroids need to be continued from six months to potentially more than two years. Other therapies that suppress the immune system could also be used, but they have not shown the same benefits.

On a last note, people with PMR are at increased risk of having giant cell arteritis, which causes headaches and a transient or irreversible loss of vision in one eye. If you have PMR and notice these symptoms, seek medical attention immediately.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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