Polymyalgia rheumatica - an inflammatory disease that causes pain and stiffness in the muscles, chiefly in the neck, shoulders, upper arms, and thighs. Symptoms of polymyalgia rheumatica usually appear quickly - within a few days after the onset of the disease. Polymyalgia rheumatica is rare in people under the age of fifty years.
Symptoms
Signs and symptoms of polymyalgia rheumatica:
- Pain in the shoulders (they are often the first symptom);
- Pain in the neck, lower back, buttocks, thighs;
- Soreness in the forearm;
- Muscle rigidity in the affected areas, especially after sleep
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or long trips;
- Limited range of motion of the affected joints;
- Pain or stiffness in the joints of the wrist or knees (less common symptom).
The first appearance of pain and / or rigidity can be accompanied by one or more non-specific symptoms of the following:
- The slight rise in body temperature;
- Fatigue;
- The general feeling of malaise;
- Lack of appetite;
- Unexplained weight loss;
- Depression.
Seek medical attention if the pain appeared recently, if it interferes with sleep and / or limit activity.
Causes
Causes of polymyalgia rheumatica is not well understood. Pain and stiffness are the result of inflammatory cells and proteins that are part of the immune system.
Inflammation is usually a response to injury or disease, but some irregularities, known collectively as rheumatic diseases, inflammation occurs in the absence of an obvious need for such a reaction.
Scientists believe that the development of polymyalgia rheumatica affects a combination of genetic and environmental factors.
Genetic factors. The gene or genes that have not yet allocated, can make a person more prone to develop polymyalgia rheumatica. The prevalence of the disease among people of Northern European bond risk polymyalgia rheumatica with its presence in the family history and the results of some genetic studies suggest the existence of such genes.
External factors or environmental factors. Some features of polymyalgia rheumatica suggest that a factor contributing to its development, can be infectious diseases. For example, the symptoms may appear after exposure to an infectious agent. In addition, it is noted that polymyalgia rheumatica in the general population growing cycles, coinciding with the seasonal increase in the risk of transmission of viral diseases. While research is not conclusive, you can most likely assume that some common viral infections are possible triggers of polymyalgia rheumatica.
The cells and proteins that cause inflammation in rheumatic polmialgii also activated in the disease known as giant cell arteritis. This disease is characterized by inflammation of the arteries and can cause headaches, jaw pain, blurred vision and other symptoms. In some cases, giant cell arteritis lead to permanent vision loss.
Some scientists suggest that polymyalgia rheumatica and giant cell arteritis may in fact be variants of the same disease. This hypothesis is not confirmed yet, but we know that approximately 20% of patients with polymyalgia rheumatica giant cell arteritis is detected; 60% of patients diagnosed with giant cell arteritis polymyalgia rheumatica.
Risk factors
Among the factors that increase the risk of developing polymyalgia rheumatica:
- Age. Polymyalgia rheumatica affects almost exclusively elderly people tend to be seventy years old and older.
- Paul. The likelihood of developing this disease in women is approximately two times higher than in men.
- Ethnicity. The most susceptible to this disease the people of Northern Europe, especially - Scandinavia.
Treatment
Polymyalgia rheumatica is usually treated with low-dose oral corticosteroids, such as prednisone. At the beginning of the treatment, the daily dose is 10-20 mg. The pain and stiffness usually becomes less pronounced in the first two or three days of treatment. Lack of relief soon after the start of treatment may indicate the wrong diagnosis.
If treatment is successful, the two-week chntyre doctor will gradually reduce the dose to the minimum at which the patient will feel fine. Most patients with polymyalgia rheumatica continue to take small doses of corticosteroids for two or three years.
Prolonged use of corticosteroids can cause serious complications such as osteoporosis, hypertension, high cholesterol, diabetes, cataracts
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and depression
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. For this reason, the patient should undergo regular screening throughout the whole course of treatment.
To prevent the development of osteoporosis your doctor may recommend supplementation
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with calcium and vitamin D. Patients may also be useful physiotherapy.
Finally, to improve their condition, patients need to make certain changes to your lifestyle, such as eating a healthy diet, exercise regularly, maintain a healthy weight. Sometimes it is advisable to wear low-heeled shoes and use some devices to facilitate daily activities.
Diagnostics
The number of tests that can diagnose polymyalgia rheumatica, is rather limited. First of all, during the general physical examination, the doctor observes the shoulder joint stiffness, swelling of the wrists and hands.
To determine the sedimentation rate of red blood cells in the blood is carried in the blood sedimentation rate. The higher the erythrocyte sedimentation rate, the greater the inflammation. As high value ESR characteristic of many diseases, this analysis can not serve as confirmation of the diagnosis of polymyalgia rheumatica.
Results of the analysis of C-reactive protein can more confidently diagnose polymyalgia rheumatica, as the values of C-reactive protein in patients is usually high. C-reactive protein is produced by the liver in response to injury or infection. Serological tests are also performed, in particular, tests for rheumatoid factor and antinuclear antibody.
Rheumatoid factor - an antibody that is sometimes found in the blood (although rheumatoid factor often found in the blood of patients with rheumatoid arthritis).
Conventional X-ray examination of joints rarely helps to identify anomalies. Magnetic resonance imaging can confirm tissue inflammation. Ultrasound and PET (positron emission tomography) studies also help confirm the diagnosis of polymyalgia rheumatica.
As a rule, the final confirmation of the diagnosis is necessary:
- Clinical symptoms and physical examination
- Elevated erythrocyte sedimentation rate and the reaction to a small dose of steroids
- Instant sharp response to corticosteroid therapy
Since polymyalgia rheumatica often accompanied by temporal arteritis, performed a biopsy tissue sample of the temporal artery.
Polymyalgia rheumatica and giant cell arteritis
According to experts, 15% of patients with polymyalgia rheumatica and giant cell arteritis is observed that develops or concurrently with polymyalgia, or after the disappearance of her symptoms.
Therefore it is very important to prevent the development of giant cell arteritis, because if left untreated it can lead to irreversible blindness, and even stroke.
