Once You Have Had Polymyalgia Can You Get It Again

What is polymyalgia rheumatica?

Polymyalgia rheumatica (poly-my-al-ger ru-mah-ticker), or PMR, is a relatively common condition that causes stiffness and pain in muscles. The word 'poly' means many and the word 'myalgia' means muscle hurting.

It can kickoff at any age from 50, but mainly affects people over the historic period of 70. More women are affected than men.

Symptoms

Polymyalgia rheumatica tin crusade pain and stiffness in the shoulders, neck, hips and thighs.

Polymyalgia rheumatica often comes on quickly, perhaps over a calendar week or two. It can start only after a flu-like affliction. The stiffness may be so severe that dressing, reaching, washing, climbing stairs or even getting out of bed may be difficult.

The symptoms are different from the anguish you may experience later exercise that your body isn't used to. The pain and stiffness from polymyalgia rheumatica is oftentimes widespread, and is worse when resting or later rest. Symptoms tin can meliorate with action or as the day goes on. The pain may besides wake y'all at nighttime.

It's also common to feel unwell or to have a slight fever, and you may lose weight. At times, tiredness tin be overwhelming, this is known as fatigue. The condition tin can too make you experience depression and broken-hearted, and depressed.

If you accept polymyalgia rheumatica, y'all are at a higher risk of getting a condition called giant cell arteritis (GCA). This involves inflammation of the claret vessels called arteries.

This needs urgent treatment as there'due south a adventure of permanent loss of your eyesight or having a stroke with behemothic jail cell arteritis.

The symptoms of behemothic cell arteritis are:

severe headaches and hurting in the muscles of the caput
tenderness at the temples, the soft part of the caput at the side of the optics
pain in the jaw, natural language or side of the face when chewing
hurting or swelling in the scalp
blurred or double vision.

If your doctor suspects behemothic cell arteritis, you'll be referred to a specialist and may take a biopsy of the temporal artery. This is where a small-scale piece of the artery is taken from the caput and examined under a microscope. You'll be given a local anaesthetic to numb the expanse.

Your doctor may start you on a high dose of steroids earlier you see a specialist to prevent possible loss of vision.

Diagnosis

There's no specific test to diagnose polymyalgia rheumatica.

Your medico will make a diagnosis after listening to you lot talk about the history of your symptoms and past carrying out a concrete examination. You'll as well have blood tests to check for any inflammation in your body, and to rule out other conditions.

If y'all're over 50 and have the following symptoms and signs your GP will probably diagnose polymyalgia rheumatica, and start treatment straight away:

new shoulder, neck, hip or thigh pain on both sides of the body, which has been present for at least ii weeks
pain and stiff muscles in the shoulders, hips or thighs in the mornings that lasts at to the lowest degree 30 minutes
loftier levels of inflammation measured by claret tests
no evidence of rheumatoid arthritis, such as bloated joints, or positive claret tests.

Y'all may be referred to a rheumatologist if there'south any dubiousness near the diagnosis or if there are complicating factors. This could be if the symptoms don't improve with steroid treatment or if you have side furnishings from the treatment.

The presence of inflammation alone won't confirm the diagnosis of polymyalgia rheumatica. Inflammation is a feature of many other conditions, including infections and rheumatoid arthritis, so your physician may do some tests to look for signs of other atmospheric condition. You may need to accept tests such as x-rays or ultrasound scans.

At that place are other forms of imaging scans that may occasionally be requested by a rheumatologist to rule out other conditions. These include magnetic resonance imaging (MRI) and positron emission tomography (PET) scans.

A condition called anaemia (an-ee-me-a), which is a lack of crimson blood cells that carry oxygen effectually the trunk, is quite mutual in polymyalgia rheumatica. Your doc may test for this. However, anaemia can too occur in other conditions.

Treatments

Guidelines setting out the best treatment and care for people with polymyalgia rheumatica country in that location should be shared decision making between a patient and their healthcare professionals.

If yous accept this status, y'all should have a treatment plan tailored to you lot, that includes:

initial dose of steroids and a schedule for when this dose will ideally be reduced and by how much, if your condition remains under control
access to educational activity focusing on the impact of the condition.

Y'all may exist given a contact phone number or helpline number for access to your doctor or nurses, if you accept concerns about any changes in your condition such as flares or side effects to drugs.

Steroids

Steroid treatment is normally very effective to care for polymyalgia rheumatica.

Steroids work by reducing inflammation. They can't cure your status, but the symptoms will improve significantly within two weeks once steroid treatment is started. Normally, steroid treatment for polymyalgia rheumatica volition be taken as tablets.

Your symptoms may virtually disappear later four weeks of steroid treatment. However, treatment commonly needs to proceed for upwards to 2 years, or occasionally longer, to stop the symptoms returning.

The steroid tablet most often prescribed is called prednisolone.

Potential side effects tin include weight proceeds and the condition osteoporosis, which can cause people's bones to go thinner and more fragile, and therefore may fracture more hands.

There are groups of people who could be at an increased risk of side effects, including those who accept:

diabetes
loftier blood pressure
a recent fracture
a peptic ulcer
a cataract
glaucoma.

If yous're in 1 of these groups, your doctor will talk to yous about drugs that may exist prescribed alongside steroids to reduce whatsoever risks.

After two to four weeks, your doctor will gradually reduce the dose of steroids.

The reduction will be fabricated in stages depending mainly on your symptoms only helped by conveying out repeated blood tests to look for inflammation.

If symptoms return when the dose is reduced, your doctor may accept to increase the dose for a short fourth dimension, mayhap several weeks, and so try to reduce it again.

You shouldn't stop taking your steroid tablets of a sudden or alter the dose unless advised past your physician, even if your symptoms have completely cleared upwards. This is because your body stops producing its own steroids, called cortisol, while y'all're taking steroid tablets. Your trunk will need some time to resume normal production of natural steroids when the medicine is reduced or stopped.

Even when yous feel well, your dr. may wish to see y'all regularly and then that you tin be assessed for signs of the condition coming back, or side furnishings from the drugs. Your doctor may want to bank check your full general health and bank check your blood pressure level, blood sugar and cholesterol. Yous may also be asked to have a bone density (DEXA) browse to check the strength of your bones.

It's recommended y'all carry a steroid card that shows what dose of tablets you're on and how long you've been taking them.

This will help if you need to see another md, for case while you're away from home, or some other healthcare professional person, for example a dentist. Please prove them the bill of fare – depending on what additional treatment y'all need, the steroid dose may need to exist adjusted.

Steroid cards are bachelor from about pharmacies.

Other treatments

Prevention of osteoporosis

Like all medicines, steroids can take side effects. One of the side effects of steroids is osteoporosis, which can cause bones to become thinner and and then fracture.

The nationally recommended treatment for this is medicine called bisphosphonates (biss-foss-fo-nates). These are a group of drugs that can dull downwards or foreclose os loss. You tin ask your doctor near handling with bisphosphonates. Examples include alendronate and risedronate.

Pain relief

Painkillers, such as paracetamol, or brusque courses of non-steroidal anti-inflammatory drugs (NSAIDs), such every bit ibuprofen or naproxen, can help ease pain and stiffness. They can be taken at the same time as steroid tablets.

Disease-modifying anti-rheumatic drugs (DMARDs)

There may be some situations where your md will want to prescribe a blazon of drug called a disease-modifying anti-rheumatic drug (DMARD), alongside steroids.

These drugs work by reducing inflammation that is causing symptoms such as pain and stiffness.

DMARDs allow a lower dose of steroid to be used.

These drugs could exist prescribed if:

your symptoms don't meliorate with steroids
you take unusual symptoms
it's difficult to reduce the dose of steroids
you lot get frequent flare-ups of your condition, where your symptoms rapidly get worse.

You lot may demand to come across a specialist to be prescribed a DMARD.

The specialist may make up one's mind to prescribe a DMARD aslope steroid tablets, which may help to reduce the inflammation and lower the steroid dose. An example is methotrexate.

If yous're taking a DMARD it's important to have regular check-ups, blood pressure checks and blood tests to check for potential side effects.

Living with polymyalgia rheumatica

Steroid handling is usually very effective at treating polymyalgia rheumatica. Notwithstanding, considering information technology can increase your adventure of getting osteoporosis, it'southward important to call back about other risk factors associated with this condition.

Smoking or drinking a lot of alcohol volition increment your chance of developing osteoporosis.

Ensuring you get enough calcium and vitamin D, and that you do some weight-begetting do will reduce the risk of getting osteoporosis.

Keeping active

If you have polymyalgia rheumatica, y'all'll need to find the right remainder between residuum and activity. Too much exercise is likely to make your symptoms worse, but activity usually helps to ease pain and stiffness in the muscles of the shoulders, hips and thighs.

Physiotherapy, including range of movement exercises for the shoulders, can help to reduce pain and maintain mobility.

Weight-bearing exercise is good for maintaining bone strength and reducing the run a risk of osteoporosis.

Weight-bearing practice is anything like jogging, walking, tennis, dancing or lifting weights, where some strength or the weight of the body is impacted on basic during the exercise. This is in contrast to pond, for example, where the water supports the weight of the torso. Walking is usually the nearly suitable weight-bearing exercise for people with polymyalgia rheumatica.

Sitting for any length of time may cause stiffness, making activities such every bit driving more hard. Stop from time to time on a long journey to stretch your shoulders, arms and legs.

Unproblematic measures such every bit a hot bath or shower tin help to ease pain and stiffness, either first thing in the forenoon or afterward exercise.

Diet and diet

Steroid treatment reduces the amount of calcium in the trunk.

If you're on steroid handling, it'south recommended yous aim for a daily intake of 700–1200 mg of calcium.

A pint of milk a day, together with a reasonable corporeality of other foods that contain calcium, should exist enough.

Appropriate calcium content of some mutual foods

Food	Calcium content
115 one thousand (4 oz) whitebait (fried in flour)	980 mg
60 thou (ii oz) sardines (including bones)	260 mg
0.two litre (one/3 pint) semi-skimmed milk	230 mg
0.2 litre (one/iii pint) whole milk	220 mg
3 large slices brown or white bread	215 mg
125 m (4 1/two oz) low-fat yogurt	205 mg
30 g (1 oz) hard cheese	190 mg
0.2 litre (1/3 pint) calcium-enriched soya milk	180 mg
125 m (4 1/ii oz) calcium-enriched soya yogurt	150 mg
115 1000 (four oz) cottage cheese	145 mg
115 g (four oz) broiled beans	lx mg
115 chiliad (4 oz) boiled cabbage	40 mg

Note: measures shown in ounces or pints are approximate conversions only.

Vitamin D

Vitamin D is needed to help the body absorb calcium.

The all-time source of vitamin D is sunlight on bare skin. Nevertheless, sunshine in the United kingdom isn't expert enough all year round to guarantee we get the vitamin D needed.

Considering of this, and because it's an important nutrient, it's recommended that we all take vitamin D supplements in the fall and wintertime months. These can be bought from supermarkets and health nutrient shops. You lot tin can also talk over this with a chemist.

There are some at run a risk groups who are advised to take vitamin D supplements all yr round, including:

people who are housebound and therefore don't go out in the sunshine frequently enough
people who wear clothes that cover their whole trunk, limiting the amount of sunshine on their skin
people with dark skin, because dark skin is not equally adept as absorbing vitamin D from sunlight, compared to pale skin.

Dorothy's story

I was 57 when I developed polymyalgia rheumatica and behemothic cell arteritis. I was caput of news and current affairs at Channel Four tv and a single parent of a child of 12.

It began with a very sore neck. I tried massage, simply it didn't work. And so my shoulders started to ache.

On a few mornings, when I woke up, I found information technology difficult to movement my artillery, though my easily moved easily. The problem would clothing off speedily, and I would forget virtually it.

Then ane morning I woke up and my arms wouldn't move at all for xx minutes. Although I was young to become the condition, I knew I had polymyalgia rheumatica, as my mother had information technology.

Information technology makes you all of a sudden feel like an old lady as you lot can't move properly.

I was given a blood exam to check inflammation levels and was put onto steroid tablets. Unfortunately, I wasn't put on a high enough dose and the aches, pains and weakness got worse.

I nighttime I was so sick and tired I couldn't even open my eyes. A few nights I had to tell my daughter to have toast for dinner because I couldn't movement.

My daughter was very upset and frightened. I would accept to go to bed equally soon as I got home. Sometimes during the day, I would get into my car in the machine park and sleep. When I was put on the correct dose of steroids I felt OK, but did cut back my social life a lot.

Eventually, I developed a terrible headache and my jaw became very stiff. I knew at once this was giant prison cell arteritis. I had to immediately take a very big dose of steroids to prevent sight loss, which is a very real chance with GCA.

For ii-and-a-half years I had to have steroids and then I was moved onto methotrexate for a year. I put on weight and my face took on a moon shape. I became tired much more easily.

Early on I joined the patient group PMRGCAuk. I found it really helpful to meet other people with the condition and swap experiences and ideas.

After iii-and-a-half years, the status went abroad. I came off the drugs. My weight went down and my face returned to its normal shape. Equally I had taken that high dose of steroids when I adult GCA, my sight is fine.

As caput of news and current affairs, I have ultimate responsibility for Channel Four News, Dispatches, Unreported World and all other news and current affairs programming. I generally work at least 60 hours a week commissioning programmes, watching films and dealing with a broad range of programmes.

I would say that I should have taken fourth dimension off work and that I had to learn to expect less of myself and to tell others I had a debilitating illness, so they should expect less of me.

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Source: https://www.versusarthritis.org/about-arthritis/conditions/polymyalgia-rheumatica-pmr/