Polymyalgia Rheumatica is a rheumatic joint disease that affects the joints of the limb roots and the cervical region. Dr. Tornero, expert in Rheumatology, talks about the symptoms and the treatment applied to this pathology.
How Polymyalgia Rheumatica affects the body
Polymyalgia Rheumatica causes intense pain, stiffness and inability to move the shoulders, neck or hips. This is accompanied by fatigue and tiredness, loss of appetite and sometimes a feeling of fever. It usually appears in women over 60 – 65 years of age; sometimes after a previous upper respiratory tract infectious episode. It may be associated with inflammation of the arterial blood vessels that originate in the aorta and carry blood supply to the head.
Symptoms of polymyalgia rheumatica
The main symptoms are pain and intense stiffness and disability, usually occurring in women over 60 years of age. These symptoms mainly affect the shoulders, the cervical spine, and the groin and thigh regions, with a sharp component felt throughout the entire musculoskeletal package. The name polymyalgia refers to precisely this: multiple musculoskeletal pains.
The joints of the hands, knees and feet are not usually affected. Symptoms begin abruptly, leaving the patient severely disabled by loss of appetite, weight loss and fatigue.
If polymyalgia rheumatica is associated with inflammation of the arteries of the neck and head (so-called temporal arteritis), the patient will also present headache in the temple region, difficulty in eating, having to interrupt chewing due to the appearance of intense pain in the masseter muscles and, in the worst case, sudden or established blindness due to lack of irrigation in the optic nerve.
The picture is characterized by very typical alterations in blood tests: very significant elevation of the erythrocyte sedimentation rate and C-reactive protein levels. Anemia and increased number of blood platelets may also appear.
If associated temporal arteritis is suspected, a biopsy of the superficial temporal artery should be performed to confirm the existence of inflammation in the arterial wall. Ultrasound of the superficial temporal artery may also help in the diagnosis.
Treatment for polymyalgia rheumatica
The disease does not respond to paracetamol or non-steroidal anti-inflammatory drugs. Symptoms should be treated with glucocorticoids (doses will be higher if temporal arteritis is associated, because of the risk of blindness). The response to these drugs is usually spectacular and, in less than 1 week, the patient may be asymptomatic, with normalization of the altered analytical parameters. Once control is achieved, the dose of glucocorticoids should be slowly and gradually reduced.
In resistant patients or those who cannot take these drugs due to contraindications (poorly controlled diabetes mellitus, glaucoma), other agents such as weekly methotrexate can be tried. If temporal arteritis is present, tocilizumab, a biologic therapy directed against a very important molecule in the inflammation of the artery, has recently been approved.
Patients predisposed to polymyalgia rheumatica
Patients over 60 years of age are more predisposed to suffer from this pathology, especially if they are women, when they suddenly develop intense musculoskeletal pain in the girdles and roots of the limbs. The patient could have previous osteoarthritis, but the pain of polymyalgia is greater and alters the analysis, which does not happen with osteoarthritis. It is due to differences from other forms of arthritis, especially rheumatoid arthritis; the latter affects more the joints of the hands, knees and feet.