What is Polymyalgia Rheumatica?
Polymyalgia Rheumatica or PMR is a chronic disease marked by pain and stiffness in both shoulders, with or without hip girdle pain and stiffness. The pain and stiffness is caused by inflammation of the joints.
The cause of PMR is currently unknown and is rarely found in people under the age of 50 years old. In fact, the average age of onset of PMR is 70 years old. A genetic link called HLA DR4 has been found in Caucasian populations, but this link is only modestly linked to the condition.
What are the symptoms?
The most common symptoms of Polymyalgia include:
- 50 years old or older
- Bilateral (both) Shoulder pain, with or without
- Pelvic or hip joint pain
- Morning stiffness lasting 30-40 minutes or more
- Pain in these areas when doing functional activities like combing your hair, turning in bed, rising from sitting
If you suspect that you have Polymyalgia, you should consult with your doctor ASAP to discuss you symptoms, organise relevant tests and guide your management.
How is it diagnosed?
Diagnosis of PMR is made on the basis of your symptoms and clinical test findings. As well as having the previously mentioned symptoms, having raised inflammatory markers in your blood, and positive Ultrasound scans, or MRI findings of inflammation in your shoulders or hips, may direct your GP to diagnosing you with PMR.
Due to the complex nature of PMR and its similar presentation to Rheumatoid Arthritis (RA), your GP may also perform tests to rule out RA and refer you to a Rheumatologist.
You may want to look at the short and long term inflammatory markers in your body that can indicate whether or not you have an inflammatory process happening in your body.
Creatine Reactive Protein (CRp) is used to assess the presence of inflammation in the body, to determine its severity, and to monitor response to treatment. It can be used to monitor acute or short term levels of inflammation in the body.
Erythrocyte Sedimentation Rate (ESR) is used to assess the amount of inflammation in the body. It is sometimes seen as a long term indicator of the level of inflammation in the body.
Rheumatoid Factor (RF) is an antibody found in the blood that attacks healthy tissue and leads to joint inflammation. Your GP may test for this to rule out the possibility of having Rheumatoid Arthritis.
X-rays and MRI
X-rays look at the condition of your joints to see if there are any signs of inflammation and joint damage.
USS or MRI of your shoulders or hips may be performed to look for signs of inflammation or joint irritation such as joint effusion, bursitis or tenosynovitis.
Depending on the results of your investigations, your doctor should discuss with you whether or not you need to take medication, see a Rheumatology specialist or both.
What can I do about it (5 tips)?
Know ‘Pain’ and what it is
Pain is the most common symptom that comes with Polymyalgia. Despite many people living with, and experiencing consistent or chronic pain, it is very common for the same people to have little understanding of what “Pain” actually is (or in other words, what research and science can currently tell us about pain).
This concept may seem confusing initially, seeing as you know what you and your body are feeling. However, spending time learning about “pain” can provide valuable insight and understanding to what you are experiencing, and provide you with powerful tools to help reduce the impact of pain on your life.
One of the most important aspects of living with Polymyalgia is to remain patient. Getting a diagnosis and finding the most effective management plan for your Polymyalgia symptoms takes time. It can sometimes take weeks and months before conditions are clarified, treatments started and symptoms are settled. Having patience during the process, and with your body as it adjusts to the condition and any medications you may be prescribed, will make living with Polymyalgia much easier and less stressful.
Having patience with your doctors as they try to understand and settle your symptom, being patient with any medications while they try to work, and being patient with yourself as you adjust to your diagnosis, will have a more positive and healthy effect on your life with Polymyalgia. This will make your life with the condition much more manageable.
Adjusting physically, mentally, and socially to having the condition can be a challenge and will take time and effort too. Remaining patient during your journey will have many positive effects on your life with Polymyalgia.
Have a good start
The symptoms of Polymyalgia when caught early can be managed well with medications and good personal management. By managing a few key aspects of your life well, you can reduce the discomfort and impact the condition can have on your life.
The following factors should be considered to help get your condition management off to a good start:
- Medical management – Discuss with your GP and Rheumatologist the most effective and current medication and management guidelines to treat PMR.
- Activity or Pacing management – Pace your day to day activities to enjoy life and maintain joint movements. Do not over do activities that may irritate your joints unnecessarily.
- Family Commitments – similar to Activity or Pacing management, manage your family commitments around your symptoms to avoid increasing you pain or irritating your joints.
- Responsibility Plan – Consider how to best manage the roles and responsibilities in your life so as not to irritate your painful joints. You may have to find alternative ways to manage your family commitments, job or hobbies until your symptoms settle down?
Discussing your management plans with the relevant people in your life, can help reduce any additional stress or difficulties that can arise in the initial stage of PMR.
If you find it difficult to ‘Be Prepared’ discussing the challenges you face with your family, friends, Doctor, Physiotherapist, Occupational Therapist or counsellor may be beneficial.
Be consistent and balance life
By maintaining a consistent healthy balance in your life while your condition stabilises, will make life much easier and less stressful on you. Whether it is at the initial stages or during any flare ups you may have of PMR, being consistent with your activity levels, diet and lifestyle choices will help you monitor and manage your symptoms more effectively. Having poor or inconsistent habits with nutrition, smoking, drinking and inactivity can have a negative effect on the management of your condition.
Taking on major physical challenges (physical work commitments, fitness challenges, being more physical within family life) or psychological challenges ( new roles at work, family challenges, increased stresses) while trying to get your symptoms under control, can make the process of getting symptom relief more challenging and less effective.
By ignoring the signs symptoms of PMR, doing little about your health, or trying to push through symptoms, you may actually be making the process of getting symptom relief harder for you and your medical team.
Applying techniques such as pacing/activity diaries, mindfulness, self awareness, or speaking to a health professional, can help make you more aware of the impact your lifestyle is having on your Polymyalgia and provide strategies to help you.
What can other people do to help me?
The management of PMR can vary between individuals, however, early diagnosis and appropriate treatment are essential to relieve symptoms, reduce joint damage and help you continue to lead a normal life.
Initially, the most important thing you can do is discuss your symptoms and diagnosis with your doctor. They may prescribe medications that can help your symptoms immediately, order tests to confirm your diagnosis and refer you to a specialist (Rheumatologist).
Finding the right doctor for you is very important. For the long term outlook, it is important to find a Doctor you feel is approachable and effective in the management of your condition. You may have to call upon them at various times in your life, therefore having a positive relationship with them, and confidence in their management of you is important.
The most common medications your doctor will manage are
- Painkillers/ analgesics
- Cortico Steroids medications or injections
Specialists / Consultant Rheumatologists
Rheumatologists are Doctors who have dedicated their professional lives to managing rheumatology conditions and have years of invaluable clinical experience in diagnosing and managing Rheumatoid conditions. They also have specialised medication prescribing rights and qualifications to help manage your condition.
The main roles of the specialist are to use their knowledge in conjunction with your GP and regular tests, to get your symptoms under control, and then monitor your condition over a longer period of time.
Rheumatology specialists appointments are often in high demand and can often be shorter than patients expect. However, rest assured your Rheumatologist understands your condition, understands what you are going through and is working hard to find the most effective management strategy for your symptoms. Due to the complex nature of Rheumatoid conditions and the effect they can have on the various systems of the body, finding the right medication and management can take time.
Depending on your symptoms, blood tests and medical history, the medications commonly prescribed by specialists in relation to Psa are one, or a combination of the following medication groups:
- Painkillers / analgesics
- Cortico Steroids medications or injections
- DMARDS (Disease modifying anti rheumatic drugs)
- Biologic DMARDS (made from living protiens and may prescribed by Rheumatologists in certain clinical circumstances)
While the thought of taking any of these medication can be both daunting and unpleasant, the medications prescribed by your GP or Specialist will have the most evidence base and research backing their effectiveness.
Based on the symptoms and issues you may be experiencing, your Specialist or GP may refer you to a variety of health professionals to help manage your condition. The most common Health professionals used by GPs and Rheumatologists, to help people with Polymyalgia are:
|Physiotherapists||Help manage pain, rehabilitation from injury, improve movement, improve or maintain function and independence|
|Occupational Therapists||Help to manage day to day tasks and function. Provide equipment to maintain function and independence, wheelchair prescription, splints and supports for upper limbs, pressure area management and pacing strategies|
|Dietitians||Help to manage diet, nutrition, obesity, malnutrition and lifestyle choices related to nutrition|
|Podiatrists||Help manage foot pains, footwear, problems and mobility issues related to the foot|
|Exercise Physiologists||Help manage general fitness, functional strength and conditioning, cardiac health, body conditioning and lifestyle management.|
When choosing which therapist to see it is beneficial to discuss your plan with your GP, research the therapist you intend to see, and ensure the therapist applies some sort of evidence based practice to the treatments they are providing you.
Remember, there is no cure for PMR, so be cautious of anybody making unfounded claims to be able to cure your condition or resolve your symptoms completely.
Many people do try alternative approaches to help their PMR and its symptoms, with mixed effect. No matter what approach or therapist you see, it is a good idea to discuss your approach with your GP, Rheumatologist or relevant health professional. More importantly, please ensure you feel better after seeing them and have a clear plan on how your condition will be monitored and self-managed
More importantly, please ensure you feel better after seeing them, have a clear plan on how your progress will be monitored, and the plan for self management.
Family, Friends and Support Networks
The most important members of your PMR team are your family, friends or support network. Attending events, remaining active and living life can be a challenge at times for all of us, however, for people with PMR , the symptoms can flare up at times and can significantly impact your life. Therefore, having people to talk to and share your highs and lows with, is very important in maintaining good physical, mental and spiritual health.
Many organisations and charities offer support, education and self-management courses for people with Rheumatoid conditions. These can help you connect with other people living with Polymyalgia or similar conditions, as well as build skills and confidence in managing your health and PMR.
Participating in physical activity with others can provide you with an opportunity to keep your joints and body healthy, while sharing positive experiences with others. Activities such as walking, hydrotherapy, Tai chi, Pilates or mindfulness sessions are all low impact activities that can be enjoyed at all stages of PMR.