Polymyalgia Rheumatica (PMR)
Description - this is an inflammatory disease affecting mainly people after the age of 60, and is rare before 50. It's cause is unknown but is probably an autoimmune condition where the body immune system attacks parts of the body. It is often associated with Temporal arteritis (giant cell arteritis) which affects the arteries to the head and is a serious condition which if not treated properly can lead to blindness. The cause of both is unknown, but possibly a viral illness or some environmental change or exposure may precipitate an attack.
The main symptoms of PMR are aches, pains and stiffness in the upper arms, legs and buttock area. It can also cause a mild temperature, fatigue, malaise, poor appetite and unintended loss of weight.
What doctors can do
- Investigations - the diagnosis is usually made from the symptoms and a blood test to show the presence of inflammation - either ESR or CRP. If these are high then treatment is essential, as sometimes (30% of cases) giant cell arteritis affecting the eyes can also be present.
- Drugs - steroid drugs (prednisone) can make a dramatic improvement in symptoms. Often quite a high dose (20 - 30mg) is required to control the symptoms and ESR, but then the dose is reduced to that low enough to keep the process under control. Most people need to continue treatment for 1-2 years, and then need careful follow up to make sure it does not recur.
Other drugs - non steroidal anti inflammatory drugs (NSAIDS like Voltaren, Brufen) can help the symptoms, but do not affect the underlying condition and can have significant side effects).
Methotrexate and Anti TNF drugs are being suggested, but do have significant side effects and anti TNF is still in the developmental stages.
What you can do
- Exercise may help in some but can aggravate pain in some people. Make it gentle exercise not hard, and if you feel worse - stop.
- Diet - a good diet of fruit and vegetables (containing antioxidants) which have anti-inflammatory actions may help.
- Rest - get plenty of rest and sleep, and take some time out during the day.
- Massage - this may sooth and help the aching muscles - but gentle, not hard tissue levels of massage.
- Low dose naltrexone - may well help (click here for more details) - and after a discussion with your health provider, should be considered.
- A good multivitamin and mineral - to make sure the cells have all the nutrients they need to function and recover
- Anti inflammatory supplements - plenty of vitamin C 1-2 grams/day, lots of grape seed extract and omega 3 fish oils 1-2 grams daily.
- Co Enzyme Q10 may help with energy transport in the muscles.
- Calcium and magnesium are essential for muscle function and relaxation and at least 800mg of each daily can help.
- Vitamin D may well hold the key to recovery from PMR, and its value is now just being appreciated. I would suggest take 5-8,000iu of Vitamin D daily.
How long? This can be a serious condition, especially if associated with giant cell arteritis (temporal arteritis), and treatment must be continued until the symptoms and raised ESR or CRP have gone down. The supplements and natural anti-inflammatories may well hasten the recovery and keep the symptoms and ESR down, so I would suggest continuing these even when the symptoms have gone. Following this, as the condition can recur, if pains return repeat the ESR; some also recommend annual ESR testing.
The Nutritional supplements I use and recommend to my patients
For my polymyalgia patients I recommend -
USANA - Cellsentials *, Biomega, Active Calcium plus, Proflavanol C, vitamin D and coquinone -
Other therapiesThere are a number of other therapies which you might like to look at. They have not been specifically included with this disease because some are a form of treatment which is applicable to most diseases and many focus on the mind, body, spirit, and the universe. These include - acupuncture, Ayurvedic medicine, energy healing, homeopathy, naturopathy, prayer, visualisation and some people with this condition might like to look at these topics (I have described them more fully on another page on this website click here .) With my personal experience and reading, I do not think that I can comment of whether one or a number of these might help. They fit well with most conventional and complementary treatments and I suspect some or even all of them can be extremely powerful - if performed by an experienced practitioner. My only caveat is that if in the course of one of these therapies, you are given potions or herbs, do check with your health practitioner that they will not interfere with other treatments or drugs you are receiving.
Nutritional supplementsI believe in today's world that nutritional supplements are so necessary as to be an essential component of any form of both prevention and treatment. Not only is today's food lacking in nutrients because of the way it was grown and processed, but also most of us make the wrong choices in diet. It is virtually impossible to obtain optimal levels of most of the vitamins, minerals and other nutrients although many people try to do so, and even then fresh produce is not available all year round. *There are many quality supplements available on the market, including –Thorne, NFS, Douglas Labs, Xtend Life, True Star Health, USANA, and Metagenics. There are others, but do your due diligence before choosing one. USANA Health Sciences has added a new adjunct to its multivitamin and multi mineral called CellSentials. These are a patented blend of phyto-nutrients which they believe affects cell signaling and growth, and increases the production of preventative antioxidants within the cell. These should add to the value of the multi, so these are the multivitamin/mineral preparation I recommend.