Polymyalgia rheumatica - causes, symptoms, diagnosis, treatment and recommendations. Polymyalgia rheumatica: disease symptoms and treatment Polymyalgia rheumatic symptoms

Polymyalgia rheumatica Is a systemic inflammatory disease of unknown cause, occurring mainly in the elderly, characterized by pain and stiffness of the muscles of the shoulder and / or pelvic girdle. Often (in 15-20%) polymyalgia rheumatica is combined with giant cell (temporal) arteritis, previously referred to as Horton's disease. Just recently, two patients with suspected polymyalgia rheumatica came for help, in connection with which I decided to tell the reader what to look for if this disease is suspected.

Historical background

The first description of this disease was provided by William Bruce in 1888, when an observation of five elderly patients with pain in the shoulder girdle and severe morning stiffness was published, and this symptom complex was designated as "senile (ie senile) rheumatic gout." Later, the disease was considered within the framework of periarthritis of the shoulder scapula. In 1945 L. Bagratuni coined the term "non-articular rheumatoid arthritis", observing eight patients with an initial diagnosis of rheumatoid arthritis, in whom the disease was atypical with lesions of the proximal extremities (shoulders) and no articular deformities. But this term did not fully reflect the essence of the disease and was not accepted by everyone. In different countries, the disease was called differently: "hemiscapular periarthrosis" (Einar Meulengracht), "rhizomelic pseudopolyarthritis" (Jacques Forestier and E. Certonncini), "rheumatoid syndrome in the elderly" (G. D. Kersley). The term "polymyalgia rheumatica" was first proposed in 1957 by H. S. Barber and soon became generally accepted. The works of L. A. Healey, who defined polymyalgia rheumatica as a systemic disease of the joints, the main manifestation of which is benign synovitis (inflammation of the joints with effusion), showed the pathogenetic groundlessness of the term "polymyalgia", which still historically continues to be used to refer to this disease.

Causes and factors of development

Currently, polymyalgia rheumatica cannot be classified as a rare pathology. According to world statistics, the incidence of the disease ranges from 28.6 to 133 per 100 thousand people over 50 years old with an age peak of 65–75 years. The disease begins exclusively in old age. It is extremely rare that the disease affects younger people (aged 45–49 years). In contrast, giant cell arteritis occurs in younger individuals. I would like to note that the disease develops almost exclusively in physically fit people without serious illnesses before the development of the disease and 2-3 times more often in women than in men. In recent years, as the awareness and alertness of doctors regarding this disease has grown, the number of diagnosed cases has steadily increased.

Despite the fact that these diseases (polymyalgia rheumatica and giant cell arteritis) have been studied for more than 50 years, their etiology remains unknown. Hereditary predisposition to this disease has been proven. HLA typing with an increased frequency reveals the HLA-DRB1 * 04 and DRB1 * 01 alleles, the detection of which serves as a risk factor for the development of polymyalgia rheumatica and giant cell arteritis. As for polymyalgia rheumatica, the role of a viral or bacterial infection in its occurrence is not excluded. However, searches for a specific infectious agent have so far been unsuccessful. However, the range of pathogens that can cause this disease currently include parvovirus, adenovirus, influenza virus, and Chlamydia pneumoniaethat stimulate the immune system in genetically susceptible individuals. For example, in Sweden in 1994, after an epidemic outbreak of parvovirus infection, there was a high rise in the incidence of polymyalgia rheumatica for 12 months after the epidemic. Cases of the onset of illness following influenza vaccination are also described. In recent years, the development of the disease began to attach great importance to the environmental factor. The role of stressful situations and hypothermia is also discussed.

Despite the name, polymyalgia rheumatica is a systemic joint disease (!), Without any signs of muscle damage ( myalgia- muscle pain). Numerous studies of painful muscle biopsies have NOT revealed any pathological changes.

In this disease, the connective tissue structures of only periarticular tissues and the synovial membrane are affected: muscle tendons in the places of attachment to bones, joint capsule, connective tissue layers of muscles, fascia, etc. Development of bursitis is mandatory. A characteristic feature of synovitis in polymyalgia rheumatica, in contrast to, is a more benign course, the absence of erosive changes in the articular bone, the absence of joint deformities and a tendency to spontaneous healing.

Polymyalgia rheumatica

The disease usually begins acutely, in the midst of complete health. You can often hear that the patient literally goes to bed in good health, and in the morning he cannot get out of bed due to severe pain and stiffness of the joints. More often, there is an increase in symptoms within 1–2 days, sometimes their development occurs gradually. Often, the onset of the disease is associated with recent acute respiratory viral infections and other infections. Sometimes a detailed clinical picture is preceded by an asymptomatic acceleration of ESR or prolonged fever without other manifestations ("fever of unknown origin"). The most characteristic manifestation of polymyalgia rheumatica is the syndrome of damage to the musculoskeletal system: pain and stiffness in the proximal extremities (shoulder and pelvic girdle). In 100% of cases, the lesions are symmetrical, although at the very beginning a one-sided lesion is possible. Constant pains of a cutting, pulling, tearing character and sharply increase with movement. Morning stiffness is characteristic. In addition, a feeling of stiffness occurs after any period of immobility. The intensity of pain is clearly related to the activity of the disease. Because of the pain, movements are also limited: it is difficult for patients to get up, sit down, raise their arms, put them behind their back, it is impossible to enter transport without help, etc. It is important to observe how the patient gets out of bed: at first slowly, wincing in pain, he turns on the side, pulls his legs to his stomach, lowers them out of bed, leaning on his hands, sits down with difficulty and only then, also with the help of his hands, gets up. Pain can also occur in other areas of the musculoskeletal system (thighs, legs, buttocks, back, even in the forearms), but not so regularly. At rest, the pain usually subsides, although in some cases it persists. Often disturbed by night pains, which are aggravated by the severity of the body, pressure. Sleep because of this becomes intermittent and restless.

The symptomatology of the disease gradually increases and reaches a maximum after 2–6 weeks. On palpation of the muscles, there is little or no soreness. There are no atrophies or infiltrations in the muscles of the shoulder and pelvic girdle, muscle strength is preserved in sufficient volume.

Arthritis in polymyalgia rheumatica usually appears several months after the onset of muscle pain: this is a symmetrical synovitis with slight edema - a sign of an exacerbation of the disease.

The features of the articular syndrome in polymyalgia rheumatica are:

a small number of affected joints in one patient;
weak severity of signs of local inflammation;
rapid subsidence of arthritis against the background of treatment with hormonal drugs;
absence of radiological changes in the joints.

Fever in patients is febrile or subfebrile, but the disease can occur without fever at all. However, in some patients, prolonged fever (weeks or even months) may be the main or even the only manifestation of the disease. Of the common symptoms, there are weight loss, anorexia, and general weakness. Also, depression often occurs, especially if the patient does not find understanding in the face of the doctor, and the prescribed therapy does not bring relief.

The following variants of the course of the disease are distinguished:

classical when polymyalgia is combined with arthritis and giant cell arteritis;
isolated , without giant cell arteritis and without joint damage;
steroid-independent , in which all the typical clinical manifestations of the disease are stopped by non-steroidal anti-inflammatory drugs (NSAIDs);
torpid when the standard dose of prednisolone does not lead to the complete elimination of pain, although it noticeably reduces their severity; increasing the dose of the drug to 25 mg gives a positive but incomplete effect;
"Mute" option, perhaps the most difficult to diagnose, which is characterized by the absence of pain syndrome and manifests itself as asthenia, depression, laboratory changes.

Among the results of laboratory studies, the most characteristic is a sharp persistent acceleration of ESR up to 50–70 mm / h. Other laboratory signs of inflammation are also determined: growth (CRP), fibrinogen is noted, acute phase proteins (alpha 2 and gamma globulins) increase. CRP is a more sensitive indicator of disease activity than ESR. An increase in interleukin-6 levels is also a marker of disease activity. A characteristic symptom of the disease is normochromic anemia, the so-called "chronic disease anemia".

Currently diagnostic criteria polymyalgia rheumatica look like this:

The patient's age is over 50 years.

Muscle pain in at least two of the three areas (neck, shoulder and pelvic girdle).

Bilateral localization of pain.

The predominance of the indicated localization of pain during the active phase of the disease.

ESR more than 35 mm / hour.

The duration of the symptoms of the disease is at least 2 months.

Restriction of movement in the cervical spine, shoulder and hip joints.

General weakness, increased fatigue, anorexia, weight loss, fever, anemia.

The first 5 criteria are considered mandatory, the rest are optional.

Recently, the criteria have been abbreviated as SECRET:

S - Stiffness and pain - stiffness and pain;
E - Elderly individuals - elderly age of patients;
C - Constitutional symptoms - general constitutional symptoms;
R - Arthritis (rheumatism) - arthritis;
E - Elevated erythrocyte sedimentation rate (ESR) - increased ESR;
T - Temporal arteritis - temporal arteritis.

Differential diagnosis is carried out with a number of diseases that occur with similar symptoms. First of all, with paraneoplastic syndrome (against the background of cancer). So, the presence of weight loss, anorexia, increased ESR in elderly patients, first of all, makes them look for a neoplastic (tumor) process, therefore, all patients with similar symptoms should undergo a thorough oncological search (it is necessary to exclude tumors of the stomach, pancreas and lungs, as the most common similar paraneoplastic reactions).

The range of diagnostic search during the examination should also include myeloma, dermatomyositis / polymyositis, diseases of the periarticular soft tissues (periarthritis of the shoulder scapula, tendinitis of the shoulder muscles, subacromial bursitis, etc.). Difficulties in making a diagnosis also arise due to the fact that similar symptoms can develop with any chronic bacterial and viral infections, with a number of endocrinological diseases, including hypothyroidism, with many autoimmune diseases, which even forces some researchers to raise the question of the presence polymyalgia rheumatica syndrome in other diseases.

Giant cell (temporal) arteritis

In 16–21% of cases, patients with polymyalgia rheumatica develop giant cell arteritis. Giant cell arteritis is a granulomatous inflammation of the aorta and its large branches with damage to the extracranial parts of the carotid artery (mainly temporal). Giant cell arteritis can occur simultaneously with polymyalgia rheumatica, but can precede it or (more often!) Join much later. Usually, giant cell arteritis develops in patients over 50 years of age. Women get sick more often than men (ratio of about 3: 1).

In most cases, symptoms appear gradually; less often the disease begins acutely, when patients can clearly mark the day and hour of the onset of the disease. The clinical picture of giant cell arteritis consists of the following manifestations:

fever (subfebrile and febrile), which is often, for a long time, the only manifestation of the disease,
torrential sweats
general weakness
loss of appetite,
decrease in body weight.
joint damage. In this disease, symmetric seronegative polyarthritis is described, resembling rheumatoid arthritis in the elderly (mainly knee, wrist, ankle joints are involved), perhaps.
often the disease is accompanied by depression.

The main clinical symptom of the disease is vascular disorders.... The arteries are twisted, their walls are compacted, painfulness along the vessel is possible on palpation. Syncope can occur, which is usually misinterpreted as epileptiform syndrome due to cerebrovascular disease in the elderly. Soreness of the scalp appears, there may be hair loss, pain in the tongue, difficulty and pain when talking, chewing and swallowing. Patients may complain of decreased vision. Sometimes blindness develops suddenly. The manifestations of vascular disorders largely depend on the localization of the process in the arterial bed. With damage to the temporal artery, a constant acute intense bilateral headache develops with predominant localization in the frontal and parietal regions. There is swelling, swelling of the temporal arteries, sharp pain when touching the skin. When the occipital artery is involved in the process, the headache is localized in the occipital region. If the arteries, on which the blood supply to the eye and eye muscles depend, are affected, then visual impairment develops, often irreversible, which may be the first manifestation of the disease. The development of blindness is the most formidable early complication of giant cell arteritis. At the same time, the damage to these arteries can be more benign and be accompanied by conjunctivitis, episcleritis, corneal edema, decreased vision, etc. If the external carotid artery is affected, then facial edema develops, swallowing and hearing are impaired. Vasculitis of the maxillary artery is manifested by a violation of chewing, unreasonable toothache. The aorta is mainly affected in chest and may be accompanied by the development of an aneurysm.

Laboratory data are not specific and confirm the presence inflammatory process... In the blood test, in addition to an increase in ESR, there is a sharply increased level of CRP and interleukin-6. Instrumental examinations (ultrasound, MRI) are of little help in the diagnosis of giant cell arteritis, since the data obtained do not allow differentiating inflammatory vascular lesions from atherosclerotic ones. Temporal artery biopsy may be helpful to confirm the diagnosis, but arteritis is not always found. However, negative results with biopsy do not allow to completely exclude this diagnosis, since in this disease, focal segmental vascular lesions are often observed.

There are diagnostic criteria for giant cell arteritis:

The onset of the disease after 50 years.

The appearance of "new" headaches: previously not noted or changes in the nature of the pains that worried earlier, and / or their localization.

Changes in the temporal artery (pain on palpation, decreased pulsation, not associated with atherosclerosis of the vessels of the neck).

Increased ESR more than 50 mm / hour.

Typical signs of vasculitis obtained from arterial biopsy.

The presence of three or more of any criteria allows for the diagnosis of giant cell arteritis.

Differential diagnosis, as well as in polymyalgia rheumatica, is carried out with a wide range of diseases occurring with damage to large vessels (including atherosclerotic).

Treatment of polymyalgia rheumatica and giant cell (temporal) arteritis

The only thing effective remedy for the treatment of these diseases are glucocorticosteroids .

Treatment of polymyalgia rheumatica is usually carried out with prednisolone. Patients "come to life" the very next day after taking small doses of prednisolone, and after 2-4 weeks, clinical and laboratory remission of the disease occurs. The standard dose of prednisolone is 15 mg / day, and it should be distributed evenly over 2-3 doses per day. Prescription of prednisolone is mandatory and should be carried out immediately upon diagnosis, which will reduce the risk of giant cell arteritis. When polymyalgia rheumatica and giant cell arteritis are combined, significantly higher doses of corticosteroids are required. Of others drugs only those that prevent complications of glucocorticoid therapy (hypokalemia, osteoporosis, arterial hypertension, steroid stomach ulcers, steroid myopathy, diabetes mellitus, cataracts, etc.) are recommended.

Remission can be achieved in 2–3 weeks, and then the selected dose should be maintained for another month. In the vast majority of patients, corticosteroid therapy lasts 2-3 years. Achieving remission is first stage of treatment... After the development of remission, the overwhelming dose of prednisolone is maintained for at least one month!

The second stage of treatment -a gradual decrease in the dose of prednisolone is done very slowly (!), under the control of ESR. The slightest signs of an exacerbation of the disease force to return to the previous dose of the hormone, that is, the rate of dose reduction should be strictly individual. Cancellation of glucocorticoids is possible on average after a year, much less often - after 6 months, if no exacerbations have occurred. However, some patients are forced to take prednisone for up to 3-10 years. The optimal maintenance dose is 5 mg / day, at which complications are minimal.

Attempts to use hydroxychloroquine, methotrexate, azathioprine and cyclosporine for the treatment of polymyalgia rheumatica have been unsuccessful or the results obtained are contradictory. Single studies have shown that the combined use of prednisolone and etanercept (a TNF-alpha receptor blocker) is effective and safe and can reduce the dose of prednisolone.

Treatment for giant cell arteritis should be started immediately to prevent blindness and internal organ damage. The dose of prednisolone usually ranges from 40 to 60 mg per day, is given in several doses and continues until ESR normalizes and symptoms disappear. In severe disease, the initial dose of glucocorticoids should be increased to 60–80 mg per day or pulse therapy followed by a switch to a maintenance dose of 20–30 mg prednisolone per day taken orally. From the means of additional therapy, it is recommended to take acetylsalecylic acid (75–150 mg) in order to reduce the risk of blindness and cerebrovascular complications.

With isolated polymyalgia rheumatica (without giant cell arteritis) forecast usually favorable for life; in the presence of arteritis, the prognosis is always dubious. With a decrease in the dose of prednisolone, recurrence of arteritis with the onset of blindness is possible; vasculitis can lead to sudden death due to stenosis and occlusion of cerebral, coronary arteries, aortic aneurysms.

Polymyalgia rheumatica is an inflammatory disease that affects the muscles of the arms, shoulders, back, and less often the pelvis and legs. Mostly elderly people are ill with polymyalgia rheumatica. The peak incidence occurs at the age of 65-70 years, but the first signs of the disease may appear at 50. Women predominate among patients. The exact causes of polymyalgia rheumatica are unknown, but researchers speculate that it is based on an autoimmune process caused by infections (such as the flu) or severe stress.

When histological examination of the affected muscles of patients with rheumatoid polymyalgia, no changes can be seen. When examining the material taken in the area of \u200b\u200bthe joints of the upper shoulder girdle, signs of an inflammatory process are rarely found. All this speaks in favor of the fact that initially, in the pathology under consideration, not muscle fibers are affected, but something else - possibly arterial vessels, since polymyalgia rheumatica is quite often accompanied by temporal (or temporal) arteritis.

Symptoms

The disease develops in two scenarios:

Acutely, when one day the patient cannot get out of bed due to stiffness and pain in the muscles.
Gradually when pain and joint stiffness builds up over time.

The main symptom of polymyalgia rheumatica is muscle pain. Moreover, the muscles of the upper limbs, neck and shoulders are most often affected. But the lower part of the body is involved in the pathological process much less often. Another feature of polymyalgia rheumatica is the symmetry of the lesion - both arms or both shoulders always hurt. The nature of the pain in polymyalgia rheumatica is cutting, pulling, pulling. The intensity of pain is directly related to the activity of inflammation in the body (determined by laboratory tests). Myalgia and stiffness are usually worse in the morning. When the patient takes a comfortable position for himself, all unpleasant sensations disappear.

In addition to pain, patients complain to doctors that it becomes difficult for them to perform any active movements with their hands and heads. But passive movements are practically not disturbed - the doctor can bend or straighten the patient's limb without problems. Against the background of pain and stiffness, other symptoms of the disease appear over time:

General weakness.
Temperature increase.
Slimming.
Decreased appetite.

Diagnostics

To date, there are no methods to accurately diagnose the disease in question. Therefore, for patients with signs of rheumatoid polymyalgia, doctors conduct studies that can identify the inflammatory process and exclude other rheumatological ailments:

Complete blood count (especially specialists are interested in ESR and the number of leukocytes).
Tests for proteins of the acute phase of inflammation and rheumatic factors.
Ultrasound and X-ray of the joints.
Doppler examination of the temporal arteries.

The diagnosis "polymyalgia rheumatica" is made to the patient only if he has the following diagnostic criteria:

Age over 50.
The presence of muscle pain in at least two areas of the body.
Symmetry of painful sensations.
High ESR.
Duration of the disease exceeding 2 months.

Treatment

In rheumatoid polymyalgia, hormone therapy is the main method of treatment. Without hormonal drugs, it is impossible to restore normal physical activity and reduce pain. Usually, after the diagnosis is made, patients are prescribed prednisolone preparations in medium doses, breaking them into several doses (3-4 per day). The dose is always selected individually, depending on the patient's weight and the activity of the pathological process, which is determined by the intensity of pain, the degree of immobilization, the content of proteins in the blood of the acute phase of inflammation and the level of ESR.

Over time, the patient is transferred to a single dose of the drug, and with a decrease in the activity of inflammation - to a lower dose of the hormonal agent. As a result, a person switches to a maintenance intake of prednisolone. Practice shows that patients have to continue such treatment for years. In addition to hormone therapy, patients with polymyalgia rheumatica are prescribed:

Non-steroidal anti-inflammatory drugs.
Vitamins.
Drugs that reduce the side effects of glucocorticosteroids.
Physiotherapy.
Physiotherapy procedures.

Forecast

If polymyalgia rheumatica develops without temporal vasculitis, and the patient receives the necessary treatment, the prognosis for life is considered favorable. If the vessels of the head are affected, the development of blindness, deafness, neurological disorders and even sudden death is possible. However, temporal vasculitis can be cured. This requires higher doses of glucocorticoids, which are prescribed in long courses.

Treatment with folk remedies

Important: for polymyalgia rheumatica, traditional medicine should not replace hormone treatment. With the help of folk methods, you can only slightly reduce the manifestations of the disease. In particular, in the fight against muscle pain, juniper tincture, compresses from a decoction of young birch leaves, rubbing with camphor alcohol, and hay dust baths have proven themselves well. To reduce the activity of the inflammatory process, folk healers recommend using honey and other beekeeping products.

Factors that can provoke an illness

It is impossible to say exactly why polymyalgia rheumatica occurs. However, according to statistics, most often pathology occurs due to the following reasons:

viral infection;
hypothermia;
prolonged stay in a stressful situation;
transferred acute respiratory infections.

Symptoms

For polymyalgia rheumatica, the following symptoms are characteristic:

stiffness of movements;
pain in the forearm, neck, spine, hips;
depressive state.

Against the background of a weakened immune system and poor human health, such additional symptoms may occur:

high temperature;
weight loss;
loss of appetite;
depression, drowsiness.

It should be noted that polymyalgia rheumatica is not a threat to life, however, the treatment process can be long.

Weakness when walking, in this case, is not caused by pain, but muscle atrophy. In some cases, the patient cannot even dress or wash on his own. It is also worth noting that joint pain may not appear immediately. Even if you have several symptoms, you should immediately consult a rheumatologist.

Diagnostics

It is quite simple to diagnose polymyalgia rheumatica, since it is almost impossible to confuse it with any other disease by symptoms alone. In addition to a personal examination, a number of laboratory tests are prescribed to clarify the reasons for the development of pathology:

clinical blood test;
blood chemistry;
blood test for rheumatic tests.

With this ailment, indicators of the inflammatory process (increased ESR and leukocytosis) are very clearly visible from a blood test. Also in the analysis there are indicators of changes in muscle structure, which also indicates polymyalgia rheumatica.

Possible complications

The disease itself does not pose a threat to life. However, if treatment is not promptly started at an early stage, complications are possible. The most common diseases are:

osteoporosis;
inflammation of the temporal artery (temporal arthritis);
diabetes;
vision problems (cataracts);
increased blood cholesterol levels.

Therefore, it is very important for the initial symptoms to immediately consult a doctor and begin treatment.

Treatment

Polymyalgia rheumatica treatment implies a rather long - from 6 months to 3 years. If you start a course of recovery at an early stage, then you can restore the joints and normalize the general condition of the patient in a couple of months.

Medication involves taking low-dose corticosteroids. At the moment, this is the most effective treatment method. Depending on what caused the progression of the disease, they may additionally prescribe:

a course of vitamins;
special diet;

As a rule, if this disease is detected at the initial stage, then taking hormonal drugs can give a positive result as early as two to three weeks after the start of therapy. In this case, the dosage is gradually reduced. As a supplement, the administration of non-steroidal drugs can be prescribed - Voltaren, Metacin.

Treatment with folk remedies

In addition to traditional drug treatment, alternative medicine can be applied at an early stage. Treatment folk remedies makes it possible to quickly relieve joint pain and weakness. However, it is worth noting that treatment with traditional medicine is best agreed with a doctor.

Folk remedies can not only relieve general symptoms, but also significantly slow down the development of the disease. The most commonly used tools are:

camphor tinctures;
corn broth;
juniper tincture;
hay bath;
tincture based on mullein and vodka.

It is important to understand that any traditional medicine is not a panacea for all symptoms of polymyalgia rheumatica. It is only effective if used in tandem with medication. Therefore, before you start using decoctions and tinctures, you should consult your doctor. Moreover, to identify the signs of the disease is not yet a diagnosis, and therefore you can begin to treat the wrong ailment that is actually present.

Forecast

With the timely detection of polymyalgia rheumatica, the treatment is quite effective. Therefore, the prognosis in most clinical situations is favorable. However, even a slight delay can cause complications.

The success of treatment largely depends on compliance with all the doctor's prescriptions. Also, for the period of the rehabilitation course, it is worth completely quitting smoking and alcohol consumption. If there is excess weight, then a diet and moderate exercise are prescribed.

What is polymyalgia rheumatica

According to the international classification of diseases (ICD-10), the pathology has the code M35.3. Polymyalgia rheumatica is also called rhizomelic pseudoarthritis. The disease is a clinical syndrome in which the patient has stiffness and soreness in the muscles of the proximal pelvic and shoulder girdles. This type of polymyalgia is more commonly diagnosed in women aged 50-75. Symptoms of giant cell arteritis, inflammation of the arteries due to the accumulation of giant cells in them, can be added to the general symptoms of this pathology.

The reasons

Doctors still do not name the exact cause of rheumatic polymyalgia. Presumably risk factors are viral infections, since patients have increased titers of antibodies to adenovirus and respiratory syncytial virus. TO possible reasons also include:

infections caused by parainfluenza viruses;
hypothermia;
giant cell temporal arteritis (Horton's disease);
a history of acute respiratory infections;
heredity;
prolonged stress.

Symptoms

Pathology is characterized by an acute onset. The patient develops a febrile or subfebrile fever sharply, symptoms of severe intoxication appear. Further, numerous myalgias are formed in the region of the thighs, shoulder girdle, thighs, buttocks, and neck. Their expression is intense, their character is cutting, pulling or twitching. The pain is observed constantly - it intensifies in the morning and after a long absence of movement.

Myalgia also occurs in muscles that experience only static stress. As a result, a person constantly has to change his body position. Symptoms are independent of weather conditions and exposure to heat or cold factors. In addition to pain, the patient is concerned about the following symptoms:

stiffness in the joints;
weakness, tiredness;
loss of appetite;
sweating at night;
difficulty in movement during elementary actions (turning in bed, lifting the head while lying down, walking up the stairs);
mincing gait with short, frequent steps;
weight loss, anorexia;
depressed state.

Possible complications

The most formidable complication of rheumatic polymyalgia is temporal arteritis. It is also called giant cell and temporal. Such arteritis is an inflammation of the aortic arch, in which the temporal artery and other large vessels of the neck and head are affected. The reason is the blockage of the vascular bed due to the accumulation of abnormal giant cells in it. The disease is accompanied by swelling and soreness in the temple and scalp. Other symptoms of giant cell arteritis include:

prolonged or occasional increase in temperature up to 38-39 degrees;
frequent headaches, even when combing hair;
lack of appetite;
dull pain in muscles or joints;
sleep disorders;
discomfort in the face in the form of pain, tingling, numbness, burning when talking or eating.

The temporal and parietal arteries with arteritis thicken, redden and become painful. Inflammation also affects the eyes, causing blurred vision, "fog" before the eyes, drooping of the upper eyelid and diplopia (double vision). These symptoms appear several months after the development of temporal arteritis. The danger of such a disease in high risk partial or complete blindness, stroke, heart attacks. The overall prognosis is favorable, since the mortality rate from temporal arteritis does not exceed the average for other age-related diseases.

Polymyalgia rheumatica can also lead to inflammatory diseases of the joints: arthritis, bursitis, synovitis. In this case, the inflammation passes after the cure of the basis of the pathology. Other potential complications of rheumatic polymyalgia may arise with glucocorticoid treatment. In order to prevent the harmful effects of such drugs, doctors additionally prescribe medications against the following possible consequences:

cataracts;
diabetes mellitus;
osteoporosis;
arterial hypertension;
steroid stomach ulcers;
hypokalemia.

Diagnostics

During the initial examination, the doctor identifies characteristic muscle pain in the patient's complaints. Since they are inherent in other diseases, when confirming polymyalgia of the rheumatic type, the following criteria are used:

age from 50 years;
myalgia in 2-3 zones - neck, pelvic and shoulder girdles;
an increase in the rate of erythrocyte sedimentation rate (ESR) above 35 mm / h;
bilateral nature of myalgias;
limited mobility of the hip and shoulder joints, the cervical spine;
complaints of fatigue, fever, anorexia, signs of anemia;
the duration of the onset of symptoms is more than 2 months.

The first five criteria for the diagnosis of polymyalgia are the main ones. To clarify the diagnosis, the doctor prescribes a biochemical blood test. It detects the following deviations:

signs of anemia;
persistent increase in ESR up to 50-70 mm / h;
an increase in the level of C-reactive protein, fibrinogen, interleukin-6 and alpha2 - and gamma globulins.

A CBC can help determine the cause of certain symptoms. During the study, the level of leukocytes, erythrocytes, hemoglobin, platelets, hematocrit is assessed. With inflammation in the body, most of these indicators increase. Another method of laboratory diagnostics is a blood test for rheumatic tests. It is necessary to determine the extent of the spread of inflammation in the tissues of organs and joints. To this end rheumatic complex is used from the following markers:

Antistreptolysin-O (ASLO). This is the identification of the body's protective cells against streptococcus antigens. Helps differentiate polymyalgia from rheumatoid arthritis.
Rheumatic factor. In rheumatoid diseases, a protein appears in the blood against which the immune system produces antibodies. The test consists in determining antibodies to its own antigens.

To differentiate polymyalgia, instrumental studies are carried out. X-ray with such a pathology does not show erosion, a decrease in the width of the joint space, signs of osteoarthritis. Synovial fluid biopsy reveals neutrophilic leukocytosis. To identify possible inflammatory changes and their localization, MRI (magnetic resonance imaging), ultrasound (ultrasound), PET (positron emission tomography) are additionally prescribed. These methods help to distinguish polymyalgia from the following pathologies:

fibromyalgia;
rheumatoid arthritis;
malignant neoplasms;
polymyositis;
hypothyroidism;
depression;
osteoarthritis.

Treatment of polymyalgia rheumatica

The whole process of treatment of rheumatic polymyalgia before the onset of stable remission takes a long time - from six months to 3 years. If therapy was started at an early stage, then it is possible to cope with the disease in a couple of months. Painful movements can be avoided by increasing the height of the chair or using a long-handled comb. So the patient will not be forced to repeat unpleasant actions. There is no need to restrict motor activity in general.

The only treatment for this polymyalgia is glucocorticoids (corticosteroids). They are prescribed in small dosages. At the initial stage of the disease, corticosteroids give a positive result within 2-3 weeks. Then the dosage is gradually reduced. Additionally, the patient is prescribed:

vitamin therapy course;
physiotherapy exercises;
special diet.

At the slightest deterioration, the dose of glucocorticoids is increased. It is possible to cancel them in rare cases after six months. To exclude possible complications from steroid therapy, vitamin D3, antiulcer drugs, and calcium-based drugs are additionally used. A prerequisite for treatment is regular monitoring of the level of electrolytes in the blood.

Medication methods

The basic medication course of therapy is the administration of low-dose corticosteroids for 0.5-3 years. The early withdrawal of such drugs leads to an exacerbation of the disease. Most patients are prescribed Prednisolone from steroid drugs. It is based on the component of the same name, which has immunosuppressive, anti-allergic and anti-inflammatory effects.

The list of indications for the use of Prednisolone includes many pathologies, including allergic diseases, rheumatic fever, diseases associated with inflammation in the joints and periarticular bursa. The scheme of using this drug for polymyalgia:

The initial dosage is 10-15 mg per day, divided into 3 doses.
If the treatment does not work for 3 weeks, then the dose is increased by 5 mg.
After achieving the clinical effect, the dose is gradually reduced: first by 2.5 mg per week, and after reaching the level of 10 mg - by 1.25 mg / week. (during this period, ESR indicators are constantly monitored).
The maintenance dose is 5 mg / day.
When giant cell arteritis is attached, the dosage is increased to 40-60 or even 60-80 mg / day. (this helps prevent the development of blindness and internal organ damage.
With prolonged use of Prednisolone, it is necessary to additionally take biophosphonates to prevent osteoporosis.
Against the background of hormonal therapy, it is necessary to use preparations with vitamin D3 and calcium in order to exclude the development of cataracts, stomach ulcers, hypoglycemia.

Contraindications and side effects of Prednisolone are numerous, so they should be clarified in the detailed instructions for the drug. The advantage of this drug is its high efficiency. If giant cell arteritis has joined polymyalgia, then Prednisolone is combined with Methotrexate, Etanercept or Azathioprine. This treatment regimen helps to reduce the glucocorticoid dosage, but keep its effectiveness at the same level.

In addition to hormonal drugs, non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed. They are less effective because they do not help eliminate inflammation. For this reason, the appointment of NSAIDs is justified only at the earliest stage of the disease and moderately severe symptoms. So, in addition to hormonal therapy or with severe pain syndrome, the following are used:

Indomethacin;
Ketanov;
Ortofen.

The advantage of the latter drug is that it comes in the form of an ointment, tablets, solution and gel. They are based on the substance diclofenac, which has anti-inflammatory properties. For this reason, Ortofen is used for diseases of the musculoskeletal system of an inflammatory and degenerative nature. It is better to study the side effects and contraindications to such a medicine in the detailed instructions for it, since they are represented by large lists. The dosage of Ortofen, taking into account the form of release, is determined as follows:

25-25 mg tablets 2-3 times a day;
75 mg intramuscularly - single administration;
3 g of ointment or gel for application to the site of inflammation.

Diet

The diet of a patient with polymyalgia should be fortified with calcium. This is a prerequisite for preventing the development of osteoporosis, which can be a consequence of taking Prednisolone. The following foods contain calcium:

cottage cheese;
milk;
almond;
tofu cheese;
syrup;
hen;
turkey;
cabbage;
yogurt;
spinach.

Food and pastries made from white flour, pastries and sweets are strictly prohibited. It is necessary to limit the consumption of potatoes, tomatoes, eggplants and peppers. It is not recommended to use such products:

caviar;
fatty fish;
fatty sour cream;
chicken eggs;
butter;
beef;
pork.

Treatment with folk remedies

Considerable experience in the treatment of polymyalgia has been accumulated by traditional medicine, but its methods should be used only as auxiliary ones. They reduce pain to one degree or another and alleviate the condition. Some doctors even advise folk remedies. If the specialist has given permission, then it is allowed to use the following recipes:

Scald a few young birch leaves with boiling water to soften them, and then apply to the sore spot. Cover with foil on top, insulate. Make such a compress every day for a week. The optimal time is before bedtime.
Place 800 g of senna in a cotton bag, boil it in 2 liters of water. Pour the broth into the bathroom with moderately hot water. Take it for 10-15 minutes.
Grind 10 tablets of Analgin, pour 300 ml of alcohol, 10 ml of iodine and camphor alcohol each. Send the tincture to a dark place for 3 weeks. after the specified period, use the composition for rubbing sick muscles up to 2-3 times a day.
Take 1 tbsp for a glass of vodka. l. the fruit of the juniper. Mix the ingredients, let them brew for 10-14 days. Consume 1 tsp daily. 2 times a day for 2 months.

Forecast

The main prognosis depends on how timely the treatment was started and whether a complication in the form of giant cell arteritis had time to form. If this pathology is not observed in the patient, then polymyalgia rheumatoid is benign, therefore, disability and deformity of the extremities can be avoided with proper therapy and rehabilitation. Symptoms gradually decrease after starting treatment. The disease resolves in about 3 years. The patient recovers and can return to normal life.

Prevention

Doctors have not developed primary methods of prevention against such a disease. Secondary intake includes maintenance doses of glucocorticoids. This is necessary to prevent exacerbations and complications of polymyalgia. Generally, doctors advise patients to adhere to the following rules:

do not overload the joints;
eat a balanced diet;
timely treat inflammatory diseases;
lead an active lifestyle, play sports;
do not abuse alcohol;
avoid hypothermia.

One of the common diseases of older age is polymyalgia rheumatica. The frequency of occurrence, according to the journal "Neurology and Neurosurgery", is about 98 cases per 100 thousand people. Women get sick 1.5-2 times more often. This pathology always begins suddenly and significantly reduces the quality of life of patients.

It is quite difficult to diagnose and requires the vigilance of a doctor. However, there are characteristic clinical signs that suggest this diagnosis.

Polymyalgia rheumatica is an inflammatory lesion of the muscles that leads to a decrease in their mobility.

It affects different muscle groups, but the most pronounced pain syndrome is localized in the muscles of the cervical and hip spine. The disease is more common in women over 50 years of age. MKB 10 code - M35.3.

The exact causes of this pathology have not been found.

As a rule, in the past, patients with polymyalgia rheumatica have a streptococcal infection in the form of:

sore throats;
acute tonsillitis;
infective endocarditis;
streptococcal pyoderma.

Other etiological factors include a general decrease in immunity, advanced age, an infectious disease.

The reasons

The pathogenesis of the disease is not fully understood. It is believed that the development of polymyalgia can occur against the background of the following factors:

Human genetic predisposition to pathology.
Unfavorable environmental conditions in the areas of residence.
The presence of other serious illnesses. It is believed that polymyalgia rheumatica can be triggered by giant cell arteritis.

Risk factors for the development of the presented disease are considered to be old age (from 60 years old), female sex, as well as the northern regions of residence.

Development mechanism

Currently, this disease is believed to be of an autoimmune nature. Group A streptococci have antigens similar to human connective tissue proteins. In response to the appearance of these microorganisms in the body, the production of antibodies begins, which act not only on the pathogen, but also on a person's own tissues.

Depending on the type of streptococcus and the characteristics of the immune system, the following tissues may be affected:

cartilage tissue (usually hyaline or fibrous);
dense connective tissue of the heart valves;
possibly muscle structures.

In polymyalgia rheumatica, according to scientists, muscles of various localization are affected. One of the proofs of this theory is the effectiveness of immunosuppressive therapy and the absence of a direct damaging factor.

Symptoms

The disease has an acute course.

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The development of polymyalgia rheumatica in humans is indicated by the following symptoms:

The clinic of a disease such as polymyalgia rheumatica can be complicated by symptoms of true arthritis or tendovaginitis.

The clinical picture of the disease

Pathology always begins acutely. The first symptom will be severe pain for no reason. Most often, it has a twitching or pulling character.

Pain syndrome has certain patterns:

manifests itself in the area of \u200b\u200bthe shoulder girdle (scapula, clavicle), pelvic girdle (more often the lumbar muscles) and neck;
pain syndrome is usually present in two or three areas;
pain is symmetrical in 100% of cases (both right and left areas are affected);
the intensity of the pain syndrome depends on the activity of the pathology - with exacerbations, the pain can take on a cutting, "dagger" character;
in 70% of cases, pain decreases or completely disappears at rest;
night pains are characteristic, which intensify with a change in body position.

The general manifestations of the disease include: persistent low-grade fever (up to 380C), which can last 1-2 weeks, loss of appetite, depression.

Further, the symptoms of polymyalgia rheumatica and myalgia rapidly progress. Stiffness of movements is added, as a rule, in the morning hours and after a long period of immobility.

After a few months (from 2 to 6), articular syndrome occurs in the form of diffuse arthritis, which has characteristic features:

a small number of joints are affected;
joint inflammation manifests itself moderately - in the form of a small synovitis or local edema;
changes in joint structures are not detected on x-rays.

These symptoms usually resolve quickly with hormone treatment.

Options for the course of the disease

The Russian Association of Neurologists and Neurosurgeons identifies 5 types of the course of this pathology, depending on the characteristics of the clinical picture or treatment:

classic - with a combination of polymyalgia with diffuse arthritis and temporal arteritis;
isolated - symptoms are limited to pain syndrome of various muscle groups;
steroid-independent - non-steroidal anti-inflammatory drugs relieve most of the symptoms of the disease. In this case, treatment with glucocorticoids is not indicated;
torpid - the most problematic option for therapy, when the treatment of the symptoms of polymyalgia rheumatica is extremely difficult (even with hormones);
latent ("Mute") - the disease proceeds imperceptibly, without a pronounced clinical picture. It is difficult to diagnose it in a timely manner, and, as a result, patients come to the doctor with an advanced disease.

Diagnostics

To accurately determine the diagnosis and receive clinical recommendations, the patient needs to consult a rheumatologist for a comprehensive diagnosis. It includes:

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General survey, examination, study of medical history. It allows you to establish how long a person has had symptoms of polymyalgia, what diseases they may be associated with, what concomitant diseases the patient has that affect the choice of treatment tactics. During the interview, patients often complain that their legs do not walk well, they are tortured in the morning severe pain, and the symptoms of the disease become more pronounced every day.
MRI. It is used to assess the state of soft tissues, allows you to track the presence or absence of the inflammatory process.
Joint ultrasound. It can be used instead of MRI, it also allows you to establish the development of the inflammatory process in the joint.
Blood test. Diagnostic criteria for this study: moderate anemia, increased ESR. Biochemistry studies of venous blood show an increase in CRP,
Microscopic examination of synovial fluid. Shows neutrophilic leukocytosis.
X-ray. In rare cases, it may show erosion, as well as a decrease in the width of the joint space. In elderly patients, x-rays can detect the development of osteoporosis.
Study of a biopsy of the synovial membrane. Confirms nonspecific synovitis.

Based on the presented studies, the rheumatologist will determine how to treat the disease and give the patient the necessary recommendations.

Treatment principles

Treatment of the disease involves taking such drugs:

Glucocorticosteroids. Most often, prednisone is prescribed. It is used at a dosage of 12 to 25 milligrams per day, gradually reducing the dose. While taking glucocorticosteroids, they are constantly monitored side effects... Treatment with this remedy can last from 6 months to 2 years.
Calcium supplements. They help prevent bone loss.
Cytostatics. For therapy, Methotrexate, Actemra are used. Medicines are used simultaneously with glucocorticosteroids. They help to increase the effectiveness of hormone therapy and can be prescribed in the case when the intake of hormones for a long period of treatment did not give the desired effect.
Non-steroidal anti-inflammatory drugs. Can be used to relieve pain.
Physiotherapy. As such, massages, gymnastics complexes can be used. Allows you to stop the symptoms of the disease in the acute period.

Polymyalgia rheumatica is a disease that is relatively rare in modern medical practice. It is associated with various in the body. And today more and more patients are interested in questions about what are the causes and symptoms of the disease. Can polymyalgia be permanently cured? Are there really effective treatments? What complications can the disease lead to? This information will be useful to many readers.

What is disease?

Polymyalgia rheumatica is a disease that is accompanied by inflammation and soreness of various muscle groups. By the way, most often the ailment affects the shoulder girdle, as well as the pelvis, but the process may spread to other tissue groups.

A characteristic feature of the disease is the fact that in the morning, after sleep, but during the day it weakens slightly. Symptoms include stiffness in movement and muscle weakness. The disease is not a threat to human life, but constant discomfort significantly impairs its quality. In addition, the disease is associated with some complications. That is why it is so important to see a doctor on time and start appropriate therapy.

Epidemiology of the disease

In fact, these muscle diseases are not diagnosed very often. According to statistical studies, residents of countries located closer to the equator are most susceptible to this disease. Nevertheless, the likelihood of developing the disease is not excluded among the population of other states.

Cases of the development of the disease in patients under 50 years of age are considered incredibly rare - most often people over 60 years old are sick. Interestingly, among women, this pathology is diagnosed about two times more often than among the male part of the population.

Muscle pain: causes of polymyalgia rheumatica

The reasons for the development of this disease are of interest to many patients. Unfortunately, today it is not always possible for doctors to find out why certain rheumatic diseases develop. It is believed that this form of polymyalgia is associated with various autoimmune processes in which the immune system malfunctions - it begins to produce antibodies that affect the body's own healthy cells.

There is a theory that such diseases are genetic in nature and are inherited from parents to children. Nevertheless, there are factors that can trigger the development of the disease. In particular, various infections can be attributed to the list of reasons - the most dangerous are adenoviruses, parainfluenza viruses and some other pathogens. In addition, it has been proven that Horton's disease, giant cell temporal arteritis, can trigger the autoimmune process.

Naturally, risk factors can also include gender (women get sick more often), old age, place of residence, etc. In any case, the disease requires a well-chosen treatment regimen.

Polymyalgia rheumatica: symptoms

Of course, the question of the features of the clinical picture is extremely important. After all, rheumatic diseases are accompanied by various symptoms. It should be said right away that this form of polymyalgia develops sharply - the symptoms appear unexpectedly, and their intensity increases every day. The "peak" of the disease occurs after about 2-4 weeks.

As a rule, at first, patients notice an increase in body temperature and the appearance of weakness. If in the first few days they are perceived as one of the signs of intoxication of the body, then after some time a person realizes that it is soreness that is the main symptom. Of course, in such cases, the patient is interested in what caused such an intense pain in the muscles. The reasons may lie precisely in the development of the rheumatic form of polymyalgia.

Most often, the ailment affects the muscle groups of the shoulder and pelvic girdle, as well as the neck. Pain in this case is almost constantly present - it can be twitching, pulling, stabbing. As a rule, in the morning, patients notice not only an increase in pain, but also the appearance of stiffness in movements. The disease affects not only actively working muscles, but also those tissues that are constantly under static stress. As a result, discomfort appears not only during movement, but also at rest - patients are forced to constantly change their body posture. The effect of temperature does not affect the condition of the muscles in any way, so cold or hot compresses have no effect. Pain also cannot be relieved with non-steroidal anti-inflammatory drugs and analgesics.

Some people have numbness in their fingertips. In addition, the development of palmar fasciitis, which is accompanied by swelling of the wrists, is possible. Sometimes, against the background of polymyalgia, arthritis of the small joints of the phalanges, as well as of the knee and wrist joints, appears.

On the other hand, the disease is accompanied by some other, nonspecific symptoms. In particular, constant bouts of pain prevent a person from sleeping, which affects his emotional state. Signs of illness include loss of appetite, weight loss (up to anorexia), as well as general weakness, depression, and sometimes even depression.

How to recognize a disease?

Unfortunately, today there are no precise diagnostic criteria. However, in medicine, it is customary to consider the presence of polymyalgia rheumatica in the event that:

the patient's age is more than 60-65 years;
during clinical analyzes observed - up to 40 mm / h and more;
the patient complains of pain in the pelvic and shoulder girdle, which is symmetrical;
there is morning stiffness that does not go away for more than 1 hour;
constant discomfort haunts a person for at least two weeks, and the number of symptoms and the degree of their severity is constantly growing;
the patient has a decrease in body weight, general weakness, depression;
with a single administration of prednisolone at a dose of not more than 15 mg per day, the patient's condition rapidly improves.

For the diagnosis of polymyalgia rheumatica, all of the above factors must be present. After all, there are other muscle diseases that are accompanied by similar symptoms.

Modern diagnostic methods

If you suspect the presence of such a disease, you should immediately consult a rheumatologist. To begin with, he will conduct an examination, prescribe the appropriate tests, and also check compliance with an international scale of criteria.

Patients take blood tests - during the study, a mild degree of anemia is detected and tomography, X-ray and ultrasound examinations are also performed. Laboratory examination of synovial (articular) fluid confirms the presence of neutrophilic leukocytosis. But a muscle biopsy for such a disease is not considered informative.

Based on all the information collected, the doctor can make a final diagnosis and develop an individual treatment regimen.

Medication methods of treatment

To date, the only really effective method of eliminating inflammation is taking corticosteroids, for example, "Prednisone", "Prednisolone" and some others. Patients are prescribed low doses of hormones. In most cases, therapy lasts about eight months, but in more severe cases, doctors recommend taking the drugs for 1-2 years. If it is too early to cancel treatment or reduce the dose of hormones, then a new exacerbation of the disease can be provoked.

Treatment of rheumatic diseases of this type also includes regular exercise therapy, which is especially important if patients suffer from stiffness of movement.

Since long-term hormonal therapy can provoke osteoporosis, as a preventive measure, patients are prescribed food supplements and mineral complexes - this will help prevent the development of calcium deficiency.

Are complications possible?

Today, many patients are interested in questions about what constitutes polymyalgia rheumatica, symptoms, treatment and causes of the disease. Of course, muscle pains bring discomfort to a person's life, but they are not a direct threat. However, the disease can provoke some complications. In particular, against its background, true arthritis of the joints often develops, which only worsens the state of health.

One of the most serious complications is inflammation of the temporal artery. This disease is accompanied by extremely severe pain in the temples, which intensifies at night. It is also possible weakening of vision, up to its loss (most often the eye suffers from the side of the affected artery). If left untreated, temporal lobe arthritis can lead to myocardial infarction.

Can the disease be treated with folk remedies?

Of course, patients wonder if there are home remedies that can cure a problem like polymyalgia rheumatica. Treatment with folk remedies is, of course, possible. For example, young birch leaves are considered quite effective. First, pour boiling water over them and let them soften. After that, the leaves must be applied to the affected muscle areas, covered with compress paper on top and wrapped in a scarf. The compress should stay overnight. Therapy lasts at least a week.

Some folk healers also recommend drinking a decoction of corn stigmas. And the tincture of mullein with vodka (applied externally) will also help eliminate pain. It is these methods that are used to eliminate a disease called polymyalgia rheumatica. Treatment, however, cannot replace hormone therapy. Home remedies can only be used as an adjunct method and only with the permission of the attending physician.

Diet for polymyalgia rheumatica

It should be noted right away that rheumatic polymyalgia requires some dietary restrictions. The fact is that the soreness is greatly aggravated by the presence of obesity. Moreover, one of the side effects of hormone therapy is the rapid increase in body fat.

Naturally, you should not strictly limit yourself in nutrition - the body must receive a sufficient amount of vitamins, minerals and nutrients. But you should limit the amount of sweets and pastries. In addition, overly spicy, fatty and fried foods should be excluded from the diet. Alcohol abuse is not recommended. At the same time, fresh fruits and vegetables, steamed lean meats, as well as cereals and dairy products will help provide the body with all the necessary nutrients. It is very important to include in the diet foods rich in calcium, since the daily intake of this mineral against the background of hormonal therapy is 1000-1500 mg.

What are the prognosis for patients?

Many people today are interested not only in the question of what constitutes polymyalgia rheumatica (symptoms, treatment and causes of the disease are described above) - they want to know what are the patients' chances of recovery? To begin with, it is worth noting that medicine knows cases of spontaneous extinction of the disease - such a phenomenon is rarely observed, but still possible. Moreover, in most cases, with the right hormone therapy and all the precautions, over time, complete recovery occurs.

But the refusal of drug treatment or an advanced form of the disease are fraught with negative consequences. In some patients, rheumatic polymyalgia becomes chronic - this form is characterized by a wave-like course with regular exacerbations.

Polymyalgia rheumatica affects an average of one in a thousand. Most often, women over 50 are sick; men and young women rarely get sick. The causes of polymyalgia rheumatica are not fully understood. According to my observations, about 70% of patients fall ill as a result of severe stress. In addition, polymyalgia rheumatica often develops as a complication of other rheumatic diseases (for example, rheumatoid arthritis), as well as a complication of certain cancers or infectious diseases, in particular severe flu. Several patients treated with me associated the occurrence of polymyalgia rheumatica with severe hypothermia.

Symptoms of polymyalgia rheumatica

In most patients, polymyalgia rheumatica begins with severe pain and stiffness in the thighs and around the shoulder joints. Many doctors, after seeing such a patient, mistakenly diagnose "arthrosis of the hip and shoulder joints" or "arthritis" or write off the patient's complaints about "osteochondrosis of the spine with pain radiating to the upper and lower extremities."

The paradox is that, in fact, neither the spine nor the joints themselves are practically affected by this disease. Polymyalgia rheumatica is inflammatory muscle damagewhich without correct treatment leads to serious complications. Therefore, I would like to draw your attention to those moments that will give us reason to assume that we are dealing not with a common disease of the joints, but with polymyalgia rheumatica.

The first most important symptom of polymyalgia, which makes it possible to distinguish it from joint diseases, is incredible weakness... Due to weakness, most of the patients are simply brought to the doctor "by hand". It is characteristic that weakness is expressed not in the whole body, but in certain muscle groups - in the muscles of the shoulders (from the neck to the elbows), thighs and in the gluteal muscles. It is difficult for patients to raise their hands up, comb their hair, wash, get up from a low chair or climb stairs, and it is difficult, I repeat, not because of pain, but because of extreme muscle weakness.

The second distinctive feature of polymyalgia rheumatica is symmetry of pain... Both the shoulders and the hips with the buttocks hurt exactly the same both on the right and on the left, with equal strength and in the same areas: the pain in the arms does not fall below the elbow joints, and the pain in the legs does not fall below the knees.

Although such symmetrical pain also occurs in other diseases, such as rheumatoid arthritis and rheumatism, in these diseases, inflammation almost always affects the "lower" joints of the arms or legs: feet, hands, wrist joints. With polymyalgia, inflammation does not reach here. In addition, arthritis occurs with obvious swelling and swelling of the joints, often with redness. In polymyalgia rheumatica, the joints do not change. There is only some "swelling" of the muscles in the area of \u200b\u200bthe shoulders and hips, and even then not always.

What else is characteristic of polymyalgia: the most severe pains are noted in the morning with the first movements of the patient. At night, only those muscles that take on the weight of the body hurt. At the same time, pain does not bother a person if he has taken a comfortable position and is in a state of complete rest.

In 70% of cases, weakness and pain in polymyalgia rheumatica are accompanied by a decrease in appetite, weight loss (sometimes significant) and an increase in body temperature.

Diagnostics of the rheumatic polymyalgia

Diagnosis of polymyalgia rheumatica for a competent doctor should not be difficult - this disease has such characteristic signs that it is difficult to confuse it with any other. To confirm the diagnosis, it is enough to do blood tests: clinical, biochemical and rheumatic tests.

In polymyalgia rheumatica, the indicators of inflammation in blood tests are simply "off scale". In addition, in the data of biochemical analysis, there is always an increase in the level of those indicators that indicate damage to muscle structures. The combination of symptoms characteristic of polymyalgia with these biochemical parameters should help a competent doctor make the correct diagnosis in time and start treatment on time. This is especially important, since polymyalgia rheumatica not "caught" in the shortest possible time can lead to serious complications.

Complications of polymyalgia rheumatica

A very common and formidable complication of polymyalgia rheumatica is inflammation of the temporal artery, the so-called temporal arteritis. Temporal arteritis usually presents with severe unilateral headache (in the temporal region), especially at night. In half of patients with arteritis, vision is significantly impaired, one eye may even go blind. In the absence of the necessary treatment, temporal arteritis can also lead to damage to the arteries of the heart and thus provoke myocardial infarction.

Treatment of polymyalgia rheumatica

To date, the only reliable treatment for polymyalgia rheumatica, which has proven itself well and allows you to quickly return a person to work, is the use of corticosteroid hormonal drugs. All other methods of treatment either give dubious results, or are still undergoing experimental use.

Of course, none of the patients are happy about the prospect of taking hormones. However, modern medicine cannot yet offer any other alternative here. And delay, as already mentioned, is fraught with serious complications - sometimes irreversible. That is why, being an opponent of hormonal drugs in many other cases, in this situation I still insist on their use. Besides curative action corticosteroid hormones are so pronounced that within 3 days after the start of their intake, all doubts in patients are dispelled. And soon after the clinical manifestations of the disease decrease, after about a month, the dose of hormonal drugs can be gradually reduced, and after 5-6 months they are usually canceled altogether.

A case from the practice of Dr. Evdokimenko.

Inna Sergeevna, a 55-year-old woman, came to the reception, accompanied by her daughter. The daughter, one might say, almost carried her mother into the office in her arms. Inna Sergeevna told me that she was tormented by weakness and symmetrical pains in the hips and shoulder joints. Moreover, as Inna Sergeevna said, it is weakness, not pain, that most of all interferes with her life. The woman does not have the strength to get up from a low chair or from a sofa. She cannot raise her hands to her head to comb her hair or style her hair.

During the conversation, it became clear that pain and weakness appeared in Inna Sergeevna after two consecutive serious emotional upheavals (loss of work and divorce from her husband). A month after the loss of her job and the subsequent separation from her husband, the woman developed pains in the hips and shoulders, and after another 2 weeks - the strongest weakness and apathy. In addition, the woman noticed that in a short time she lost about 4 kg. However, the patient associated this weight loss exclusively with experiences and lack of appetite.

When these symptoms reached their apogee, the daughter persuaded Inna Sergeevna to see the doctors. In one of the clinics, the woman underwent X-rays of the shoulder and hip joints, and also took blood tests. X-ray examination, however, did not reveal any changes in the joints. But the blood tests revealed serious "inflammatory" deviations from the norm: the woman had several times higher ESR (ESR) and C-reactive protein.

Despite this, for some reason, Inna Sergeevna was treated for "arthrosis of the shoulder and hip joints." Naturally, the woman did not get better from such treatment. Moreover, a month later she began to develop a complication - temporal arteritis and severe headaches began.

Then my daughter, seeing that the treatment was not helping her mother, “rummaged” on the Internet and, having read there my article on polymyalgia rheumatica, she diagnosed Inna Sergeevna herself. Then she persuaded my mother to come to my appointment.
During the examination, I noticed the characteristic symmetry of the pains and the obvious weakness of the woman. Blood tests confirmed the diagnosis of polymyalgia rheumatica, which the daughter put to her mother herself. After all, the test data spoke of a serious inflammatory reaction in the body.

I had to prescribe hormonal treatment to Inna Sergeevna. I prescribed prednisone to a woman in fairly high doses - this was required by the situation. And a day later, Inna Sergeevna felt much better. The weakness diminished so much that the woman "got to her feet" again. And after 2 weeks, weakness, pain in the shoulders and hips disappeared altogether. A little later, the headaches also completely stopped.

At first, the patient continued to take high doses of prednisone. But over the next 5 months, we were able, gradually reducing the dose of prednisolone, to completely abandon the drug. After observing Inna Sergeevna for another year, I was convinced that everything went well in her case. However, it is not known how it would have ended if the woman had continued to be treated for "arthrosis" for another 2-3 months.