Polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease. Inflammation of the shoulder, back and neck muscles causes pain and stiffness in the regions here. The hip muscles can also be affected. PMR is the Giant cell arteritis very similar, often both diseases even occur together. Researchers disagree on whether they are two different diseases at all, or whether polymyalgia rheumatica and giant cell arteritis are not consequences of the same disease process. For this reason, the PMR is also often added to the Vasculitides counted. 1,2,3,4,5

Rheumatism guide: shoulder/neck skeleton in X-ray view

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Epidemiology/frequency

Polymyalgia rheumatica is almost exclusively contracted by people who are over 50 years old are. In this age group, after rheumatoid arthritis, it is the most second most common inflammatory rheumatic disease. In Europe, about 0.06 percent of the population is affected, which corresponds to 60 sufferers per 100.000 inhabitants. Women are affected more often than men. The disease occurs almost exclusively in Europe, North America and Australia, in Europe more often in northern than in southern regions. The duration of the disease is between six months and four years. In some cases, it can last up to ten years. 1,2,5,6

Rheumatism guide: Schematic representation of a spinal column

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Causes

The causes of polymyalgia rheumatica are not known. What is clear, however, is that it is Autoimmune disease In this age group, it is the most common form of rheumatoid arthritis after rheumatoid arthritis, in which the body’s immune system does not react to pathogens and foreign bodies, but against the body’s own proteins. Thereupon a defense mechanism is set in motion, which attacks the own organism. The result is inflammation in the very areas of the body where these autoimmune reactions take place. The triggers for these abnormal reactions in polymyalgia rheumatica are unknown. However, there are indications for connections with synovitis and bursitis as well as genetic predispositions, since there are familial accumulations. However, PMR does not belong to the classical hereditary diseases. 1,2,3,4,5,7

Rheumatism guide: blood collection tubes and a stethoscope on a tablet

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Symptoms

Typical for Polymyalgia rheumatica is a pronounced and symmetric Weakness the muscles in arms and legs with particular Muscle pain. Often also develop headache. A diurnal progression of symptoms can be observed: As a rule, the pain begins at night and is strongest in the morning. In the course of the day and especially in the evening, the symptoms improve again, but do not disappear completely. In the case of very pronounced pain, the patients are in their Mobility severely restricted, Have trouble standing up and move with a noticeably small-stepped gait. You feel ill, have increased temperature (rarely fever), suffer from loss of appetite and increasingly lose Body weight. With disease onset can abruptly depressive moods enter. 1,2,3

Rheumatism guide: A patient suffering from polymyalgia rheumatica massages his neck

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Ratgeber Rheuma: Teaser image for ada app

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Diagnosis 1,2,3,4,5

In a discussion with the patient (Medical history), the doctor first asks about the general condition, the feeling of illness and the typical symptoms such as muscle pain. In the case of physical examination it primarily checks the functional capacity and pain sensitivity of muscles and joints.

The following laboratory values blood and urine samples can provide valuable indications of polymyalgia rheumatica:

  • elevated blood cell sedimentation rate (BSG)
  • Elevated levels of C-reactive protein (CRP), a marker of inflammation in the blood
  • decreased hemoglobin concentration, Anemia (anemia)
  • elevated liver enzymes, especially γ-GT

Thanks to imaging techniques such as Ultrasound (sonography) and Magnetic resonance imaging Magnetic resonance imaging (MRI) can also be used to visualize typical inflammations and thus localize them more precisely.

Professional associations have established the co-occurrence of certain symptoms with simultaneous exclusion of other diseases (such as giant cell arteritis and rheumatoid arthritis) as indicative of PMR. These include: 8

  • Morning stiffness longer than 45 minutes
  • Hip pain and limited mobility
  • In the Blood test shows a negative result for the rheumatoid factor and the antibodies anti-CCP2
  • No pain in the small joints
  • Simple or simultaneous Bursitis (bursitis), inflammation of the biceps tendon and synovitis (synovitis) of the shoulder joint, as well as inflammation of the hip joint and thigh bone.

Ratgeber Rheuma: A doctor palpates a patient's right shoulder

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Therapy 1,2,3,4,5

Medications containing cortisone are the central therapeutic agents in the case of polymyalgia rheumatica. They have an anti-inflammatory and analgesic effect and are administered in higher doses at the beginning of treatment. Is Absence of symptoms If the patient’s condition is improved and new laboratory results show better, lower inflammation values (CRP, BSC), the dose will be adjusted and reduced accordingly to keep side effects such as bone loss (osteoporosis) or increased blood sugar low. In most cases, cortisone therapy lasts for several years. Due to the possibility of early relief of symptoms, it is important to inform the patient in detail about the necessity of the entire duration of therapy.

Immunosuppressants can be used additionally, if the cortisone dose cannot be reduced to the necessary extent. Immunosuppressants suppress the body’s own faulty reactions in the immune system that are triggered by the autoimmune disease. However, they also increase the risk of other infections and put a strain on the liver and kidneys. Therefore regular control examinations of these organs is necessary.

Anti-inflammatory, pain-relieving drugs (NSAIDs, non-steroidal anti-inflammatory drugs) can be used for treatment in a mild course of polymyalgia rheumatica.

Physiotherapy is not basically part of the therapy. However, many patients with polymyalgia rheumatica are already at an advanced age. Preserving muscle mass and muscle function and reducing the risk of falls are therefore very important, an personal exercise program is recommended.

Like all people with inflammatory rheumatic diseases, polymyalgia rheumatica patients should be monitored for a healthy diet with little meat, lots of fruit and vegetables, and foods rich in omega-3 fatty acids, such as oily fish.

Ratgeber Rheuma: A patient takes the medication prescribed by her doctor

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