Muscle Pain and Stiffness May be Due to Polymyalgia Rheumatica

Dr. Norman B. Gaylis

Polymyalgia rheumatica is an inflammatory disorder of the muscles characterized by pain and stiffness in the shoulders, neck, arms, lower back and legs. It occurs mainly in people over the age of 50 and is more common in woman than in men. Many people, when developing the symptoms initially believe that their aches and pains are simply due to a flu-like illness or possibly getting older. Unfortunately, this leads to a somewhat simple diagnosis being left untreated in many people for far longer than is necessary. It is because the symptoms are so nonspecific that the diagnosis is often times missed.

As the condition progresses, the pain including the stiffness may increase to the point where the sufferer cannot lift his/her arms or get out of a chair without great pain; evening turning over in bed or getting off the toilet seat may be very difficult and painful. At times, this condition may be associated with fatigue, depression, sweats and a total feeling of debilitation.

It is unfortunate that many times this diagnosis takes awhile to be made as it is a very simple illness that can be treated once other problems have been ruled out. A person having the symptoms I have just described should have a thorough examination to exclude other causes of muscle pain, fatigue and weakness. In particular, one should rule out more serious conditions such as malignant disorders, other arthritis disorders and an autoimmune inflammation of the muscles called polymyositis. In addition to a thorough physical exam, blood tests and x-rays may be needed to help make a diagnosis but the most pertinent blood test that helps clench the diagnosis is an abnormally elevated sedimentation rate.

The medicine used for the treatment of polymyalgia rheumatica is exclusively and specifically prednisone. This medicine is a cortisone derivative and significantly reduces inflammation in the muscles. It is the one and only drug used to treat polymyalgia rheumatica and, while there are obviously side effects-to prednisone, the therapeutic benefit that it provides compared to other treatments, makes the choice easy. The response to prednisone is dramatic and diagnostic in and of itself.

The role of the rheumatologist is to find a balance between the effects of the disease versus the potential side effects of the medication. This is done watching the course of the disease by periodically testing the blood sedimentation rate and maintaining the lowest possible dose of prednisone. The ultimate objective is to wean the patient off the medication when the disease goes into remission which usually happens 6 months to 2 years after the initial onset of symptoms.

In a small number of patients, an associated condition causing inflammation of the blood vessels on the side of the head, namely the temporal artery, can occur. This is a disease known as temporal arteritis which needs to be recognized as it can lead to blindness.

If you think you have symptoms that could be caused by polymyalgia rheumatica, please speak to your physician as this is a very treatable condition and there is no reason for patients to suffer unnecessarily from the debilitating pains and functional loss of polymyalgia rheumatica.