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 What is it? Polymyalgia Rheumatica (PR) is an inflammatory condition that most often affects older patients. Typical symptoms include severe proximal muscle and joint stiffness/pain, most often in the shoulder girdle and hips. The exact cause is unknown but might be auto-immune, perhaps a genetic pre-disposition and systemic inflammation or infection. A diagnosis is made based on a collection of common signs and symptoms. Usually blood tests and imaging are part of confirmation of the diagnosis. The disease has an excellent prognosis and responds dramatically to an extended course of systemic corticosteroids.
Symptoms/Risks Initial symptoms include bilateral muscle and joint pain in the shoulder girdle and hips. Joint and muscle stiffness typically occur after long periods of rest. Stiffness tends to improve after 1-2 hours of activity. True muscle weakness is not a feature of the disease, which helps to separate PR from other conditions. Pain will often limit range of motion of the shoulders and hips as well. PR typically only affects patients over the age of 50, usually between ages 70 and 80, and it is about two to three times more common in women. It has a higher incidence in those of northern European ancestry, however can affect people of all ethnic backgrounds.
Sports Medicine Evaluation & Treatment In order to separate PR from other conditions that have similar symptoms, physicians will often order a number of blood tests and imaging studies. A workup often includes testing inflammatory markers in the blood (i.e., erythrocyte sedimentation rate (sed rate), C-reactive protein (CRP), and white blood cell count (WBC)) which are often elevated, and imaging (x-rays, ultrasound, and/or MRI) of affected joints to rule out other causes of joint pain including. PR has an excellent prognosis, often improving with a low dose of oral steroids, such as prednisone. Response to treatment is typically fast, with near resolution of symptoms within 24- 72 hours of treatment. A quick response to steroids helps to confirm the diagnosis. If symptoms do not respond quickly to steroids, then other causes of the pain should be considered. Most patients gradually reduce their prednisone dose after a period of 1-2 years. If the patient has been limited in their abilities for quite some time, physical therapy may be needed to return to the previous level of activity. Recurrence is possible but rare, especially when slowly tapered off steroids.
Return to Play For at least 48 hours after the injection, patients should focus on rest and gentle activities like walking. Patients are recommended to avoid high intensity or grueling weight bearing activities like prolonged standing, jogging, or heavy lifting. After 48 hours, patients gradually return to activity using pain as their guide.
Injury Prevention Given that we do not know much about the cause of PR, there is nothing known that one can do to prevent it. Long-term steroid use, however, can cause various side effects like weight gain, loss of bone density and weakening of bones (osteoporosis), high blood pressure, diabetes, and clouding of the lenses of your eyes (cataracts). Therefore, it is important the patient is followed closely by their doctor to look for these issues. Consideration should be given to a vitamin D and calcium supplement to help prevent bone loss, and the patient should be encouraged to eat well, exercise regularly, get enough sleep, and consider using assistive devices like rolling luggage and grocery carts to make daily life easier.
Return to Play Given the significant response to oral corticosteroids, most of those affected by Polymyalgia Rheumatica are able to return to sports/activities within a matter of days after starting treatment. Return is possible when pain and stiffness have resolved. Apart from management of long term risks of steroids, patients need not be concerned or limited. AMSSM Member Authors References Category: [Back] |
