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Polymyalgia Rheumatica

POLYMYALGIA RHEUMATICA AND GIANT CELL ARTERITIS IN THE ELDERLY

Polymyalgia rheumatica (PMR) meaning pain in many muscles (poly=many; myo=muscle; algia=pain) and giant cell arteritis (GCA) a progressive disorder causing severe pain in the temporal area are not new diseases. They have been around for more than 100 years, but have been commonly labeled as senile rheumatic gout, senile arthritis, myalgias or rheumatism. PMR and GCA sometimes go hand and hand, but not always. Patients with PMR are closely monitored for symptoms of GCA and vice versa.

Let’s take a look at two cases: Mr. Jones and Mrs. Smith. One day, Mr. Jones, a 60-year-old healthy man, suddenly experienced severe aching, stiffness and pain in his shoulders, hips and wrists. Within several weeks, he had gone from walking and exercising daily to not being able to get out of bed or even comb his hair. However, after taking small doses of Prednisone, his symptoms completely subsided within 24 hours. Mr. Jones will be closely monitored for symptoms that may signal the onset of GCA.

Mrs. Smith, a 75 year old woman had been having severe throbbing in her right temporal area. This pain was different than what she experienced from frequent tension headaches. Sometimes, while watching TV, she felt like a curtain was pulled partly over her eyes. Her physician ordered a biopsy of her right temporal artery and it revealed that she had giant cells with inflammation of the artery wall. Mrs. Smith’s symptoms improved after taking Prednisone, but in larger doses. She will be monitored for symptoms of PMR.

PMR and GCA usually affect people over the age of 50, and its incidences increase with age. Much more common among people of northern rather than southern European descent, PMR and GCA are almost exclusively reported in whites and are more prominent in women. Although no one knows the exact cause of these diseases, aging, infection and genetics seem to play an important role.

While patients with PMR experience severe muscle pain and stiffness usually in the neck, shoulders, thighs and hips, those with GCA experience severe pain usually in the temporal area. Both onsets can be either sudden or progressive, both patients can feel fine one day and terrible the next and Prednisone is usually the choice treatment in low doses for PMR and high doses for GCA.

Despite their similarities, their severity does differ. PMR, a more benign and less serious disease, affects the patient’s daily routine with morning stiffness, muscle aching, pain and headaches, but can be controlled with lose doses of Prednisone. GCA, however, a more critical disease, not only causes incurable headaches, but can also cause long term effects such as weakness, blindness and even stroke. This is why more aggressive doses of Prednisone are used for treatment of GCA to prevent serious complications.

By Dr. Yong H. Tsai
Published in The Daytona Beach News-Journal
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