What is the cause of Polymyalgia rheumatica (PMR)?
The cause of PMR remains poorly understood. For unclear reasons, the body’s immune system attacks the lining around joints and tendons causing inflammation, pain and stiffness. This is sometimes a “self-limiting” disease, in that it can go away on its own. The cause for this is also unknown.
How common is PMR?
PMR affects adults over the age of 50, with an average age of onset being 70. It is most common in Caucasians, and twice as likely to occur in women. PMR affects about 0.5% of the North American population.
What are the risk factors for PMR?
Even though the cause is unknown, viral infections and possible genetic factors may predispose a person to develop PMR. These risks are not well understood.
What are the warning/early signs of PMR?
Symptoms associated with PMR can start slowly and progress over several months or develop more rapidly over weeks. The main symptoms include pain and stiffness in the pelvis, shoulder, hips and neck. Symptoms also include low-grade fevers, fatigue and weight loss.
How is PMR diagnosed?
There is no one specific test for diagnosing PMR, which can be difficult to confirm. Diagnosis is based on clinical history and a physical examination carried out by your primary care physician. A thorough examination of your joints, range of motion, and muscle agility can help your physician identify symptoms associated with PMR. Specifically, your physician may be looking for a history of joint pain related to the shoulders or hips. X-rays, imaging or blood tests can then be done to help identify inflammation and rule out other diseases.
In cases of Giant cell arteritis (GCA), a detailed head and neck physical examination, including an eye assessment, is performed. A biopsy (test on a small piece of tissue) of a superficial artery around the temple area is usually done to help confirm a diagnosis of CGA.
What body parts are affected by PMR?
The pelvis, shoulder, hips and neck are most commonly affected by PMR.
With GCA, the blood vessels are impacted, which can affect the head, scalp, eyes and other parts of the body.
What are the symptoms of PMR?
Symptoms of PMR include pain and stiffness in the pelvis, shoulder, hips and neck, and sometimes low-grade fevers, fatigue and weight loss. Prolonged morning stiffness is a key symptom and usually lasts longer than 30-60 minutes. The pain and stiffness typically worsen with lack of activity. The symptoms make it difficult for individuals to lift their arms or reach down to tie their shoes.
People with GCA can experience:
- Scalp tenderness
- Jaw pain with chewing
- Blurry, double or loss of vision
- Severe persistent headaches, mostly around temples
Treatment of PMR involves medications and therapies to address inflammation, pain and joint function. Early treatment of the disease can help protect your shoulder and hip joints and restore function and range of motion.
Glucocorticoid (prednisone) is the drug of choice for treating PMR. This strong anti-inflammatory steroid medication can achieve quick symptom relief within days. The dose and duration of treatment is case-specific, but most people will require treatment for 6-12 months. In some people, PMR can last longer, but for most, it eventually resolves with effective treatment and does not typically recur. While low doses of prednisone are used for PMR, patients who also have Giant Cell Arteritis (GCA) may require a higher dose.
While non-steroidal anti-inflammatory drugs (NSAIDs) are not usually effective in treating PMR, they can help reduce inflammation and pain. NSAIDs may especially be used if there are additional symptoms after treatment with prednisone, or to reduce the dose of prednisone.
Physical therapy can reduce pain and stiffness in the shoulders and hips caused by PMR. Strengthening muscles around the joints can improve function, and exercise can help to reduce fatigue.
A physiotherapist (PT) is a healthcare professional with advanced training and registered to practice by their provincial/territorial college. PTs can develop an individualized rehabilitation program designed to help you increase your strength, flexibility, range of motion, and general mobility and exercise tolerance through a wide variety of therapeutic treatments and strategies. These include exercise prescription, physical interventions, and relaxation, in addition to advising you on other techniques for reducing pain and increasing your overall quality of life.
As PMR symptoms improve with treatment, people are usually encouraged to resume their normal activities including exercises as tolerated. However, during treatment, physical activity can be an important part of reducing pain and stiffness in hips and shoulders.
A common misconception is that a painful joint requires rest. On the contrary, lack of movement can cause muscle weakness and worsen joint pain and stiffness. Light or moderate physical activity protects joints by strengthening the muscles around them, increasing blood flow to the joint and helping promote normal joint regeneration. Physical activity can also improve mood and lessen pain.
Physical activity refers to any movement that increases heart rate through the activation of your muscles, while exercise is considered a structured, planned, repetitive and purposeful activity with the goal of improving or maintaining a component of physical fitness (source: Canadian Society for Exercise Physiology). An increase in physical activity, even in small increments, can help relieve arthritis symptoms and improve your daily function.
Physical activity strengthens the muscles and connective tissues around your joints, helping support joints that have been damaged by arthritis. Physical activity includes all those activities that you do as a part of everyday life – such as vacuuming the floor, walking to work, even gardening. These kinds of activities can be very beneficial for your joints and can help you maintain and improve your mobility.
There is no conclusive evidence to suggest that what you eat can make arthritis either better or worse. However, being overweight can put excess strain on your joints. To work normally, your body needs food to supply energy, vitamins and minerals. Healthy eating will help you manage your weight and give you the energy to complete your daily activities, as well as promote a strong immune system, and bone and tissue health.
Four ways to improve your nutrition include:
- Limit saturated and trans fats: A healthy diet should include modest amounts of unsaturated fats. Saturated and trans fats should be limited.
- Choosing the right amount and types of fats can help you achieve and maintain a healthy body weight and improve your overall health. Olive oil and cold-water fish such as salmon, trout or herring are examples of healthy choices.
- Reduce sugar intake: Sugar contains “empty” calories and has no nutritional value. This includes honey and syrup as well as white, brown, cane and raw sugar. Limit or avoid adding sugar to drinks and cereals. Although artificial sweeteners contain fewer calories, it is best to get used to food being less sweet. Use dried, unsweetened fruit like raisins, cherries or dates to sweeten cereals since they provide vitamins, minerals and fibre.
- Eat more vegetables and fruit: Vegetables and fruit should make up the largest component of your diet. Keep in mind that the sweetest fruits have high sugar content so it’s best not to overdo it. Try to have at least one vegetable or fruit at every meal and while snacking. Besides being an excellent source of energy, vegetables and fruit boost your fibre intake, which helps with digestion and weight management. They are also loaded with antioxidants, which help boost the immune system and may help maintain healthy cartilage.
For more information, visit our Eating Well online module.
Relaxation and coping skills
Developing relaxation and coping skills can help you maintain balance in your life, giving you a greater feeling of control over your arthritis and a more positive outlook. Relaxing the muscles around a sore joint reduces pain. There are many ways to relax. Try meditation or deep breathing exercises. Listen to music or relaxation tapes. Imagine or visualize a pleasant and restful activity, such as lying on a beach.
For more information about relaxation and coping skills, visit our online module on Managing Chronic Pain.
Living well with arthritis
There is a lot you can do to take control and actively manage your arthritis. Below we have listed a few resources to help you learn more about actively managing your arthritis to live better.
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Our online courses are jam-packed with helpful tips and information. Each course is devoted to a specific issue or symptom linked to arthritis.
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