Polymyalgia rheumatica

Diagnosis

The diagnosis of polymyalgia rheumatica can be challenging because its symptoms overlap with other conditions like rheumatoid arthritis, spondyloarthritis, pseudogout, myositis, and connective tissue diseases.

The diagnostic process typically involves asking about one’s medical history and conducting a physical exam, which may involve gentle movements of the head and limbs to see how well one can move. The healthcare provider will focus on typical polymyalgia rheumatica signs and symptoms while considering other potential illnesses.

Tests may be required to further understand the source of the discomfort and stiffness. These tests may include:

• Blood tests: Despite the absence of a specific test for diagnosing polymyalgia rheumatica, indicators such as erythrocyte sedimentation rate (sed rate) and C-reactive protein, in addition to examining complete blood counts, also help identify signs of inflammation, aiding in the diagnosis and management of polymyalgia rheumatica.
• Imaging tests: MRI scans can help identify alternative causes of shoulder pain, such as joint issues. Ultrasounds and other imaging tests can also assist in distinguishing polymyalgia rheumatica from other conditions with similar symptoms.
• Biopsy of the artery in the temple: A biopsy involves removing a small sample of the artery for examination under local anesthesia to look for signs of inflammation. This is often recommended if the healthcare provider suspects giant cell arteritis, which is sometimes associated with polymyalgia rheumatica. Giant cell arteritis is a condition that can cause serious complications if not treated promptly.

Treatment

Treatment for polymyalgia rheumatica typically leads to symptom improvement. This treatment regimen may extend for one to two years, although in some cases, it may need to be prolonged further, particularly in instances of relapse.

Treatment options may include:

• Medications
  • Corticosteroids: Treatment for polymyalgia rheumatica starts with a low dose of a medication called corticosteroids. If the symptoms get better, the dosage of the steroid is slowly reduced over one to two years. Sometimes, the symptoms might come back, and one may need to take a low dose of steroids for a longer time to prevent flare-ups.

Regular check-ups is necessary to assess treatment effectiveness and monitor for side effects such as weight gain, bone density loss, high blood pressure, diabetes, and cataracts.

• • Vitamin D and calcium: These supplements help prevent bone loss while on corticosteroid treatment. This is often recommended for people taking corticosteroids for more than three months. The recommended doses are about 1,000 to 1,200 milligrams of calcium and 600 to 800 international units of vitamin D.
  • Methotrexate: This may be prescribed at the beginning of the treatment or later if there is an occurrence of relapse or inadequate response to corticosteroids. Methotrexate, a pill that suppresses the immune system, may be recommended for some patients along with corticosteroids.
• Physical therapy: In general, many individuals undergoing corticosteroid treatment for polymyalgia rheumatica can resume their usual activities. Individuals with polymyalgia rheumatica who have been less active may be advised to engage in regular physical activity. Maintaining muscle strength and joint flexibility is crucial, and recommended exercises include using a stationary bike, swimming, and walking. These activities not only enhance overall fitness but also aid in alleviating symptoms associated with the condition.