Polimialgia Reumatica Treatment Options
Polimialgia reumatica and giant cell arteritis (GCA) are both overlapping inflammatory rheumatic diseases whose causes have not been identified. They share some clinical features and happen in adults over the age of 50 years old. In the United States of America and the United Kingdom it is estimated the annual incidence of GCA is 188 to 220 cases per one million people. For polimialgia reumatica the annual incidence varies from 120-1120 per million depending on the country of choice.
Giant cell arteritis is easier to diagnose than polimialgia reumatica. The typical presenting symptoms are a new, not normal headache that feels like head pain that is associated with an increased erythrocyte sedimentation rate or a high C-reactive protein level. The most feared side effect of gca is permanent visual loss. This occurs in approximately 15% of cases and is the reason why GCA is treated as a rheumatologic emergency. Other possible but less common signs and symptoms include jaw or tongue numbness which happens as a result of decreased blood to the head and jaw due to inflammation narrowing the arteries. Upon further testing about half of sufferers will have vascular inflammation affecting several main arteries throughout the body.
Pain and stiffness of the shoulders, neck and hips are the hallmark features of polimialgia reumatica. Approximately one third of sufferers will also have weight loss, depression and slight fever. The condition has no known cause and can develop very rapidly overnight or over a few days. The symptoms are experienced in the muscles which will make movements of the joints painful and stiff. It can be experienced on both sides of the body. Because it mimics a range of neurological, hormonal and endocrine disorders the final diagnosis often takes some time.
A standard approach of corticosteroids is used for both the treatment of GCA and polimialgia reumatica. The best practice is to find the lowest dose possible that can still provide symptomatic benefit, this is termed a maintenance dose. This is desirable to decrease toxicity from the drug. During the current day there is no set way for determining this dose for each individual other than trial and error. Typically people will begin on medium or high doses and this is monitored and then lowered gradually.
More than half of patients with polimialgia reumatica and about one third of GCA have a relapse of the condition and therefore need to stay on corticosteroids therapy for several years. A large number of relapses happen in the first year of treatment in conjunction with the corticosteroid dosage being reduced to less than 7.5mg per day.
In conjunction with a medical approach some sufferers of polimialgia reumatica have benefit from lifestyle and dietary changes and nutritional supplements. Trying to reduce the amount of stress in your life and promoting a calm and relaxing mind can benefit some individuals. Improving your diet and decreasing the amount of processed foods that you eat and increasing the amount of fresh fruit and vegetables can only be beneficial to helping your body cope with both these disorders. Also the addition of natural supplements that are aimed at reducing inflammation can help.