As soon as I was diagnosed with PMR I concentrated all my spare time into reading everything I could find on the subject. I became totally immersed for three weeks and at the end decided I would put all the information into a short, ordered, easy to read form. This was not only to allow me to get a clear picture of exactly what I was dealing with but also to help my family understand the reasons for any changes I was having to make to my normal activities etc. Please bear in mind that I hadn’t heard of PMR three weeks before putting this summary together: some of the details may be debatable but hopefully the overall picture is correct. Hope it's useful.
Polymyalgia Rheumatica (PMR) Summary
Overview:
• PMR is an inflammatory condition primarily affecting adults over 50 with the highest incidence occurring in people aged 70-80. Women are affected about 2-3 times more frequently than men. It causes pain and stiffness in the shoulders, neck, and hips and symptoms develop quickly and often worsen in the morning. The exact cause is unknown but involves immune system dysfunction and inflammation, with genetics (PMR is more common in people of Northern European descent) and environmental factors playing a role; possible environmental triggers are viruses, vaccines, stress.
Inflammation in PMR:
• PMR involves chronic inflammation of synovial tissues, bursae, and periarticular structures, driven by immune system dysfunction and elevated inflammatory cytokines. Left untreated, inflammation can lead to significant pain, stiffness, muscle weakness, and overlap with giant cell arteritis (GCA), which can cause serious complications like vision loss.
Diagnosis:
• Diagnosis is based on symptoms, blood tests (elevated ESR/CRP), ruling out similar conditions like rheumatoid arthritis, positive response to steroid treatment.
Prognosis:
• The condition resolves naturally: Within 1-5 years is said to be usual but exceptions seem to be fairly common. Steroids manage symptoms during this time. Relapses are common. With treatment, symptoms can be effectively controlled, and complications minimized.
Treatment:
• Corticosteroids (prednisone/prednisolone) are the primary treatment, rapidly relieving symptoms by reducing inflammation.
• Corticosteroids do not cure PMR but manage symptoms until the disease resolves naturally. Without treatment, PMR symptoms can significantly affect quality of life which can lead to other health problems.
• Prednisolone is effective in the reduction of inflammation in PMR but it also mimics cortisol, and when taken in sufficient doses over an extended period, it suppresses the hypothalamic-pituitary-adrenal (HPA) axis signalling the body to reduce or stop its own cortisol production and leading to adrenal atrophy, where the adrenal glands shrink due to lack of use.
• Full recovery of adrenal function can take weeks to months after stopping prednisolone. If prednisolone is tapered too quickly the adrenal glands cannot recover fast enough to start producing sufficient cortisol to counteract the reduction in prednisolone. This can cause fatigue, weakness, low blood pressure, and in severe cases, an adrenal crisis which can be fatal.
• To manage this, prednisolone needs to be tapered gradually. During stress (e.g. illness or surgery), additional prednisolone may be required.
• Key points of treatment for PMR patients include gradual tapering, monitoring for symptoms of adrenal insufficiency and adjusting doses during stress. Proper management minimizes risks while controlling PMR symptoms effectively.
Self-Management:
• Follow medical treatment and taper steroids as instructed by a COMPETENT PRACTITIONER.
• Adopt a healthy lifestyle with anti-inflammatory foods, regular exercise, and stress management. Avoid smoking and alcohol
• Protect bone health with calcium, vitamin D, vitamin K2 and Omega 3 supplements.
• Stay active but avoid overexertion. Avoid repetitive exercises. Walking is a particularly good exercise.
Key Points:
• PMR is self-limiting but in the meantime will require corticosteroids for effective symptom control.
• Lifestyle changes and regular medical monitoring can support recovery and minimize steroid side effects.