Ask doctors: there are no new remedies for PMR

Dear doctor: I am a 77-year-old man who used to exercise regularly. I was diagnosed with polymyalgia rheumatica a couple of years ago. Sometimes I feel it will disappear, and other times it seems to get worse. Are there any new remedies?

Dear reader: Polymyalgia rheumatica, also known as PMR, is an inflammatory condition that affects the joints and muscles, most often in the neck, shoulders, hips, thighs and lower back. Some patients report a gradual onset of the condition. For others, it appears quickly, apparently overnight.

The symptoms of PMR include significant muscle pain, accompanied by continuous stiffness. Both tend to increase after periods of rest or inactivity, and can be severe enough to interrupt sleep. Pain and stiffness are more pronounced in the morning. The stiffness caused by PMR often improves within a few hours after waking up, being active also helps, but the pain persists. Additional effects may include flu-like symptoms, such as fever, malaise and exhaustion. PMR is rarely seen in people under 50, and is most often diagnosed at age 60 or older. It is also more common in women than in men.

Although the cause of PMR is unknown, it is suspected to be an autoimmune disease. That means that the body's immune system is attacking its own tissues, leading to systemic inflammation that is causing pain and stiffness. Research on PMR has also suggested a genetic component. The condition seems to be more common among people of northern European descent than among those of the Mediterranean.

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As you probably know, after living with the condition for a few years, the primary treatment for PMR is corticosteroids, such as prednisone. Patients report a rapid reduction of pain and stiffness often two or three days after starting steroid therapy. Due to the possible complications associated with steroids, including an increased risk of infection, diabetes, high blood pressure and osteoporosis, the goal is to find the lowest possible dose to control pain. Once the symptoms are under control and the results of certain blood tests show improvement, steroid therapy is gradually reduced to the lowest effective dose.

There are currently no new treatments for the condition. Sometimes a class of medications known as disease-modifying anti-rheumatic drugs, or DMARD, is used to reduce steroid dependence. And there is a growing interest in the use of monoclonal antibodies, which are molecules created in the laboratory that act on or with the immune system.

Some people living with PMR report improvement when they switch to a low-inflammation diet, such as Mediterranean diets or DASH. Foods that are associated with anti-inflammatory properties include green leafy vegetables, fruits, nuts, whole grains, fatty fish and green tea.

If you have not already done so, we recommend that you tell your doctor every time your symptoms get worse. A challenge of aspiring to a minimum dose of any medication is that the dose may fall below what is necessary. Ask your doctor if you need a slight adjustment in your medication.

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