Polymyalgia rheumatica – rheumatic pains that occur simultaneously in different muscle groups. Disease is characterized by muscle pain and stiffness, more pronounced in the morning and decreasing during the day; pain is usually localized in the muscles of the neck, shoulders, spine, hips, buttocks. Polymyalgia rheumatica affects mainly women over 50 years of age. There is no specific diagnosis, the disease is recognized on the basis of clinical and laboratory signs. Treatment includes NSAIDs, corticosteroids, and chemotherapy drugs. The course is benign, the disease is successfully resolved during treatment.
ICD 10
M35.3 Polymyalgia rheumatica
Meaning
The etiological factors are unknown. The leading importance of disorders in the immune sphere and heredity is obvious, the triggering role of sensitizing and infectious (adenovirus, parainfluenza virus) agents is discussed. Giant cell temporal arteritis (Horton’s disease) can provoke and maintain the course of this disease.
Symptoms
The onset of pathology is acute – with fever and severe intoxication. Against this background, multiple myalgias develop in the shoulder girdle, neck, hips, buttocks. Muscle pain in the distal extremities, as a rule, is not typical, except in cases of concomitant arthritis, arthrosis or arteritis.
The severity of myalgia is intense, the character is pulling, pulling or cutting. The pain is constantly present, intensifying in the morning and after a long absence of movement; during the same periods, muscle stiffness is noted. Myalgias are expressed not only in the process of performing voluntary movements, but also in muscles experiencing static load, so patients are forced to constantly change their posture or body position. Polymyalgia rheumatica is not associated with a change in weather conditions, its intensity does not change significantly under the influence of cold or thermal factors.
Muscle pain is forced to restrict movement (especially active) in the cervical spine, shoulder girdle, hip joints. Elementary actions become difficult: lifting the head in a lying position, turning in bed, squatting, getting up from a chair, walking up stairs, dressing, combing hair. With rheumatic myalgia, the patient develops a characteristic mincing gait with frequent short steps.
The clinic of polymyalgia rheumatica reaches its peak 1-2 months after the appearance of initial symptoms. During this period, the pain can become so intense and excruciating that it entails complete immobilization of the patient. Palpation of the interested muscles in polymyalgia rheumatica does not reveal any special changes – hyperthermia, seals, increased soreness, muscle atony and atrophy. Patients are still worried about fever, anorexia, weight loss, weakness.
The clinic of polymyalgia rheumatica can occur with the phenomena of true arthritis, which usually develops a few months after myalgia. Large joints are more often involved in arthritis, sometimes an effusion forms in the joint cavity; the pain is moderate and unstable. When the small joints of the hand are interested, moderate diffuse edema is observed with the development of carpal tunnel syndrome, tendovaginitis and flexion contracture of the fingers.
Diagnostics
A rheumatologist is engaged in the diagnosis and treatment of polymyalgia rheumatica. Specific changes in peripheral blood in polymyalgia rheumatica are not detected; only moderate anemia and an increase in ESR are detected. In the study of venous blood for biochemistry, there is an increase in CRP with negative laboratory tests for RF and LE cells.
Radiologically, erosions and a decrease in the width of the articular gap are extremely rare; in elderly patients, osteoarthritis phenomena are detected. Ultrasound of the joint and tomographic (MRI, PET) diagnostics in polymyalgia rheumatica confirm inflammatory changes. Microscopy of synovial fluid reveals the presence of neutrophilic leukocytosis. Examination of the synovial membrane biopsy reveals signs of moderate nonspecific synovitis. Muscle biopsy in polymyalgia rheumatica is not informative.
Treatment and prognosis
The basic course of pharmacotherapy for polymyalgia rheumatica includes taking low-dose corticosteroids (prednisone, etc.) for 8 months. In some cases, the course is extended to 2 years. Early withdrawal or reduction of the dosage of corticosteroids can lead to a new exacerbation of polymyalgia rheumatica.
In the process of corticosteroid therapy, it is necessary to prevent osteoporosis – the appointment of calcium-containing mineral complexes, dietary supplements, a diet rich in calcium, based on the daily Ca norm. With moderate severity of clinical and laboratory changes, therapy for polymyalgia rheumatica may include only the appointment of NSAIDs. To reduce joint stiffness, physical therapy classes are held.
Polymyalgia rheumatica, not associated with giant cell arteritis, proceeds benign and resolves in 50-75% of patients within 3 years. The lack of medical supervision and treatment of polymyalgia rheumatica leads to deformity of the limbs and disability. Prevention has not been developed.