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General Medical Questions
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Question : I have been diagnosed with polymyalgia rheumatica. What is it? What treatment is used for the associated pain?
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The Trusted Source
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Howard LeWine, M.D.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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June 02, 2014
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Polymyalgia rheumatic (PMR) is a condition that causes the sudden onset of aching, stiffness and fatigue in older adults. Symptoms are due to arthritis, tendonitis and bursitis, especially in the shoulders and hips. And the stiffness tends to be worse in the morning.  People often feel pain in the thighs and upper arm muscles. That’s why the term “myalgia” (meaning muscle pain) is part of the name. 

The cause is unknown. It is also unclear why it only affects older adults.  Occasionally, PMR happens in combination with temporal arteritis (TA). This is another, more serious, condition in which arteries also become inflamed.

A combination of things typically confirms the diagnosis:

  • The symptoms
  • The examination
  • Blood tests, including increased ESR and CRP (which indicate inflammation in the body)
  • The absence of another explanation for the symptoms

The standard treatment for PMR is a low-dose of a corticosteroid, such as prednisone, 10 to 20 mg daily. Some doctors base the dose on weight. But rarely is a dose of more than 20 mg/day required. The dose is slowly tapered to the lowest effective dose. Or, if possible, discontinued. 

Many people with PMR require a year or more of treatment. If the required dose of prednisone is too high, your doctor may recommend other immune-suppressive drugs, such as methotrexate or hydroxychloroquine.

In most cases, these drugs are highly effective at reducing pain. Acetaminophen or tramadol may also relieve pain.  Anti-inflammatory drugs, such as ibuprofen or naproxen, are not recommended. That’s because corticosteroids usually control inflammation well and there is significant risk of intestinal ulcers when corticosteroids and other anti-inflammatory drugs are combined.

Steroids can weaken the bones. Therapies to help prevent weak bones include calcium, vitamin D and bisphosphonates (such as alendronate or risedronate).

Finally, physical therapy can help maintain or even increase range of motion in sore joints and muscles.

 

 

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