Polymyalgia Rheumatica is difficult to diagnose, easy to treat
For more than a year, Mary Margaret Carmichael lived with aches and pains that were so severe she was scared to lift her granddaughter to give her a hug.
She went to numerous specialists, none of whom were able to diagnose the cause of her persistent low-grade fever and stiffness and pain in her neck, shoulders, back and hips.
It was very frustrating," says Carmichael, now 63. "I couldn't turn my neck. If I was driving, I'd have to turn my whole body to see if traffic was coming. I thought I was going to have to live with this pain for the rest of my life."
A rheumatologist at The University of Texas Medical School at Houston finally determined that Carmichael had polymyalgia rheumatica, a form of arthritis that is relatively simple to treat but often difficult to diagnose.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, an estimated 700 out of 100,000 people older than 50 develop polymyalgia rheumatica, a disorder that literally means pain in many muscles.
Aging doesn't hurt this bad
"There is a misconception that these aches and pains are part of the aging process, but these aren't your average aches," says Carmichael's physician, Dr. Frank Arnett, professor of internal medicine.
"Polymyalgia rheumatica can be devastating," he said. "Patients are in pain. If they can get any sleep, when they wake up, they are so sore they don't want to get out of bed. It's a systemic illness. They lose weight. They become depressed."
Women are twice as likely as men to develop the arthritic condition, and while the cause of polymyalgia rheumatica is not known, it appears that genetic and environmental factors play important roles in the disease.
Stiffness is the main symptom, and in many cases, it begins suddenly in otherwise healthy people. It usually manifests in the neck, shoulder and hip joints, but also can affect the hand and knee joints.
A simple blood test
Oftentimes, patients have symptoms for at least a year before they are accurately diagnosed, Arnett says. This is because the disease can mimic other disorders, including rheumatoid arthritis.
The good news, Arnett says, is that the disease is "so treatable and inexpensive to do so." A simple blood test called the erythrocyte sedimentation rate measures inflammation in the body and can be used to confirm the diagnosis.
"If the test reveals an abnormality, we give them a trial of a low-dose steroid," Arnett says. "Usually, within 24 to 48 hours, their symptoms are gone."
The medication works to reduce pain, inflammation, stiffness, fatigue and fever. Regular exercise may also help maintain joint flexibility, muscle strength and function.
Carmichael said she was reluctant to try the prescribed therapy because she was worried about the side effects of taking a steroid. "I didn't want the puffiness or the weight gain, but I didn't want the pain either."
Low dose therapy
Arnett says the dose is so low that most people don't experience significant side effects. Patients start with 15 milligrams of prednisone, and gradually the dosage is cut back to between 2.5 to 5 milligrams. Eventually, they may be able to discontinue the medication altogether.
"I noticed a difference immediately," Carmichael recalls. "I got all of the benefit and none of the side effects. I'm now down to 7.5 milligrams, and I have not had any pain."
Arnett says it is important for patients who are experiencing stiffness and muscle pain in their neck, shoulders or hips to see a rheumatologist.
If polymyalgia rheumatica is left untreated, it could develop into giant cell arteritis, a disorder that results in inflammation of arteries in the head and neck, which could lead to sudden blindness or stroke.
"People don't have to live with the pain," Arnett says. "It is so easily treatable."