The exact causes of onset, at present, continue to remain unknown. However, it is assumed that the origin of polymyalgia rheumatica is a combination of genetic and environmental factors.
With an early diagnosis, it is possible to avoid the danger of complications, sometimes even very serious ones. The treatment consists in taking corticosteroids, powerful anti-inflammatory drugs with non-negligible side effects.
Polymyalgia rheumatica resembles, from certain points of view, various pathological conditions; when it is in its infancy, it can be mistaken for flu, at a more advanced stage, however, it can remember rheumatoid arthritis. site of inflammation (joint in the case of rheumatoid arthritis).
RHEUMATIC POLYMYLIA AND HORTON'S ARTERITIS
Often, those who suffer from polymyalgia rheumatica also suffer from Horton's arteritis at the same time. The latter is an inflammation of the medium and large caliber arteries, especially those that cross the temporal area of the head (at the temples).
Horton's arteritis is a treatable pathological condition, but compared to polymyalgia rheumatica it can develop far more serious complications (especially if diagnosis or treatment is late).
EPIDEMIOLOGY
Every year one person in 1,200 gets sick with polymyalgia rheumatica. Those affected are often elderly (65-70 years old) of female sex (women are twice as affected as males).
Furthermore, individuals from Northern Europe, particularly Scandinavia, are particularly prone to manifesting the disorder.
Horton's arteritis and rheumatic polymyalgia: epidemiology
Except for the incidence, the other epidemiological characteristics just described also apply to Horton's arteritis. This confirms the similarities between the two pathological conditions.
According to some statistics, about 15-30% of people with polymyalgia rheumatica also suffer from Horton's arteritis, while about half of those who have Horton's arteritis have (or have been in the past) from polymyalgia rheumatica.
RISK FACTORS
As anticipated, there are some conditions that favor the onset of polymyalgia rheumatica. They are:
- Old age. People aged 65-70 and older are the most affected. It can happen, but it is rare, that people around 50-55 years get sick.
- Female sex. In women, polymyalgia rheumatica is twice as common as in men.
- Scandinavian origin. A higher incidence of polymyalgia rheumatica was noted in individuals from Northern Europe, in particular from Sweden, Finland and Norway. However, the reasons for this have not yet been understood.
Due to the symptoms it causes, polymyalgia rheumatica resembles a normal flu; however, unlike the latter, it does not resolve spontaneously without treatment.
The symptoms and signs are different, but they all involve an inflammatory process that begins in the muscles of the neck, shoulders and hips.
Muscle pain (myalgia) is the main pathological manifestation: it first appears on one side of the body only, then on both sides.
In addition to myalgia, the patient usually experiences:
- Stiffness and soreness of the areas affected by myalgia, therefore: shoulders, neck, hips and limbs.
- Limited mobility of the muscles near the joints
- Sore knees and wrists
- Medium-high fever (37-38 °)
- Sense of fatigue
- Sense of being unwell
- Loss of appetite
- Unexplained decrease in body weight
- Depression
MUSCULAR PAIN (MIALGIA)
As mentioned, muscle pain is the key symptom that characterizes polymyalgia rheumatica; at the beginning, it arises in specific points of the body: neck, shoulders and hips, subsequently, it tends to involve the limbs (both upper and lower) and the muscles next to the joints (knees and wrists, in particular).
Figure: the red areas highlight the anatomical areas, where pain and muscle stiffness are felt.. From the site: http://pdg.molig.com
The patient, if not treated, complains of pain when he has to perform the most normal daily activities, such as getting out of bed or a chair, getting in or out of the car, getting dressed, combing his hair, etc.
SENSE OF RIGIDITY €
In the same areas of the body affected by myalgia, the patient also feels a sensation of muscle stiffness. This is the second important sign of polymyalgia rheumatica.
This rigidity is perceived above all in the first hours following awakening; over time (in the absence of appropriate treatments) it tends to spread to other parts of the body.
DEPRESSION
One wonders why the patient with polymyalgia rheumatica sometimes also suffers from depression. The reason is simple: within a few days, sufferers find it difficult to carry out even the simplest daily operations. This fact, especially on an elderly person with other ailments, can have serious psychological repercussions.
WHEN TO SEE THE DOCTOR?
At the beginning, polymyalgia rheumatica resembles a common flu and can be mistaken for it. However, in a few days the symptoms, instead of improving, drastically worsen: this is the signal that you need to contact your doctor for a thorough examination.
In general, the following manifestations should not be overlooked:
- Appearance of new muscle pains
- Appearance of stiffness where pain was already felt
- Difficulty in carrying out simpler daily activities
- Limited joint mobility
COMPLICATIONS
Complications of rheumatic polymyalgia arise due to the patient's neglect of the symptoms he experiences.
This leads, in less serious cases, to a worsening of health conditions and the degree of motor impediment, while in the most unfortunate situations Horton's arteritis can appear. It is not yet clear how the latter develops from polymyalgia rheumatica. , however, this happens in a fair number of patients.
How to recognize "Horton's arteritis?"
Horton's arteritis can cause serious consequences, such as complete blindness. Therefore, it is essential to recognize the main symptoms early on: persistent headache (especially in the temples), sudden loss of vision, double vision and pain in the jaw or neck.
With early diagnosis and prompt therapeutic intervention, Horton's arteritis can be cured, avoiding the danger of the aforementioned complications.
If polymyalgia rheumatica is suspected, the erythrocyte sedimentation test, performed on the patient's blood, can provide significant information. This is based on the assessment of the rate at which red blood cells settle to the bottom of the tube containing them. The faster this movement (elevated ESR), the more likely there is an ongoing "inflammation.
Another blood parameter, detectable during an inflammatory state, is the high presence of a particular protein, produced by the liver, known as the C-reactive protein.
Both tests, both that of sedimentation and that of C-reactive protein, are rapid and non-invasive.
Blood tests also evaluate:
- The presence of infectious agents, such as viruses or bacteria
- Kidney function (creatinine levels)
- Thyroid function (amount of thyroid hormones)
THE INSTRUMENTAL TESTS
Instrumental tests are particularly useful, because they provide in-depth images of the internal tissues (muscles, joints, bones, etc.) and clarify the precise cause of myalgia (if doubts remain). In fact, if there is an inflammation, this is recognized, as well as a possible other cause triggering the painful sensation.
Instrumental diagnostics consists of: nuclear magnetic resonance (MRI) and ultrasound.
Nuclear magnetic resonance imaging provides images of an individual's bone and joint structures. Helps distinguish rheumatoid arthritis, which attacks the joints, from polymyalgia rheumatica, which involves the muscles.
The ultrasound, on the other hand, shows the health of the muscles and soft tissues in general.
In both cases, the patient is not subjected to any harmful radiation.
DIAGNOSIS OF HORTON'S ARTERITIS
If Horton's arteritis is added to polymyalgia rheumatica, the latter must be diagnosed as soon as possible, to avoid unpleasant consequences.
In these cases, in addition to the recognition of symptoms and blood tests (the same as for polymyalgia rheumatica), ultrasound Doppler and PET (positron emission tomography) are essential.
THE FUNDAMENTAL CRITERIA FOR A CORRECT DIAGNOSIS
In summary, in order not to confuse polymyalgia rheumatica with another pathology (for example, rheumatoid arthritis or flu), it is essential to remember the following diagnostic criteria:
- Over 55 years of age
- Sensation of pain in the shoulders and / or hips
- Feeling of muscle stiffness, especially in the morning upon waking
- Persistent symptoms that show no signs of improving within two weeks
- Blood tests showing an internal inflammatory state
- Rapid improvement of symptoms with the initiation of corticosteroid-based therapy (see the chapter dedicated to therapy).
The other existing pharmacological treatments are, rather than alternatives to corticosteroids, medicines to be taken in combination.
From a therapeutic point of view, a balanced diet, vitamin supplementation and regular physical exercise (commensurate with the patient's age) play an essential role.
The healing times, even after an early diagnosis and scrupulous care, are very long: from one to two years.
THE CORTICOSTEROIDS
Side effects of corticosteroid treatment:
- Osteoporosis
- Hypertension (high blood pressure)
- Muscle weakness
- Glaucoma
- Cataract
- Weight gain
- Diabetes (blood glucose levels increase)
- Sensitive skin and easy bruising
- Weakening of the immune system
In subjects with polymyalgia rheumatica, the first choice corticosteroid administered is prednisolone.
The beneficial effects are immediate, but treatment should be continued until the physician deems the inflammation exhausted.
The drug is taken orally and daily. At the beginning, the doses are high, but after a few weeks they can be reduced to the minimum quantity capable of controlling the inflammatory state.
The only real problem, linked to prednisolone (and to all corticosteroids) is represented by the side effects: these are numerous and, if not carefully controlled, can become very dangerous.
TREATMENTS TO BE ASSOCIATED
The doctor may prescribe some medicines to be combined with corticosteroids, to lower the doses of the latter and alleviate the side effects. These are drugs capable of counteracting inflammation and its triggering agents.
- Methotrexate (or methotrexate). It reduces the action of the immune system (immunosuppressive action), consequently moderating the inflammatory state. It allows to limit the doses of corticosteroids.
- The anti-TNFs. TNF is a molecule with a central role in inflammation. Anti-TNFs act against TNF, reducing the inflammatory state.
SOME TIPS TO FOLLOW
Here are some helpful medical tips to follow if you want to limit the side effects of corticosteroids.
First of all, it is good to correct the diet, so as not to favor the rise in blood pressure and blood sugar (glucose in the blood). Therefore, added table salt should be avoided and fatty foods, sweets, sugars should be limited. and alcohol, in favor of fruits, vegetables, whole grains, lean meats and fish.
Secondly, the intake of calcium and vitamin D supplements against osteoporosis is recommended.
For further information: Diet for Rheumatic Polymyalgia
Finally, if age permits, it is important to stay active, as physical exercise (even moderate) allows for bone turnover, maintenance of muscle tone and stability of body weight.
