Diagnosis, evaluation of painful muscle condition treatable

INDIANAPOLIS – Aches and pains can seem inevitable as we age, and arthritis usually gets the blame. But if you wake up one morning and your neck, shoulders or hips are suddenly so stiff you can barely move, you may have a different problem – polymyalgia rheumatica.

This condition, also called PMR, triggers inflammation of the muscles and tissues around joints. The cause is not known. Although PMR sometimes starts slowly, it’s more likely to develop quickly over just a few days or weeks. Some patients report feeling as if “run over by a truck.”

The pain and stiffness from PMR:

Occurs most often in the neck, shoulders and hips. The lower back, buttocks and thighs also may be affected, but lower arms and legs usually are not.

Are usually worse in the morning and may make it hard to get out of bed.

Make it difficult to get dressed, especially to put on a sweater or jacket.

Get worse when you’re inactive for a while, such as during a long car ride.

You’re not likely to get PMR if you’re under age 50. However, after that it becomes increasingly common, especially among women 70 and older. Along with these symptoms, people with PMR may have numbness or tingling in the fingers, fatigue, weight loss or a slight fever.

These symptoms can make it tough to get through the day, and some people become depressed.

There is no single imaging or laboratory test that can identify PMR with certainty. Moreover, it may resemble other diseases with similar symptoms, such as rheumatoid arthritis, fibromyalgia, shoulder tendonitis or infection.

To make the diagnosis, your doctor will consider your symptoms and do a physical exam. Two blood tests can help confirm the diagnosis – one checks your erythrocyte sedimentation rate; the other, your C-reactive protein. Both measure inflammation in the body, which, however, also can be increased by other conditions.

PMR is treated with prednisone, which controls inflammation and relieves symptoms. For most people, symptoms completely resolve within a week with treatment. If symptoms aren’t relieved quickly by prednisone, other illnesses have to be considered.

According to Stefan Monev, M.D., a rheumatologist with St. Francis Medical Group, a comprehensive evaluation is required to make a confident diagnosis of PMR before committing patients to a long course of steroid therapy, which may be associated with side effects.

The prednisone dose is gradually tapered and adjusted to the lowest amount that controls your symptoms. Most people can stop taking prednisone after one to two years. Mild to moderate exercise can help you maintain your muscle strength while you’re healing.

In a small proportion of patients with PMR, a more serious condition, temporal arteritis, may develop. It causes inflammation of the blood vessels and can lead to blockage of a vessel feeding the eye and result in vision loss. Symptoms include pain in the temples, pain when chewing and visual changes.

Establishing diagnosis requires clinical evaluation, blood tests and often a biopsy of the vessel in front of the ear. Prompt diagnosis and treatment are crucial to decrease the risk of visual impairment. The treatment is also with prednisone, but it requires higher doses.

More information about PMR can be found at http://stfrancishospitals.adam.com/content.aspx?productId=117&pid=1&gid=000415.

To learn more about rheumatology services at St. Francis Hospital & Health Centers, go to www.stfrancishospitals.org/SFMG/DesktopDefault.aspx?tabid=193.