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Polymyalgia rheumatica (PMR)
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Polymyalgia rheumatica (PMR)

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Polymyalgia rheumatica (PMR), an inflammatory disorder that causes widespread muscle aching and stiffness, especially in your neck, shoulders, thighs and hips.

Although some people develop these symptoms gradually, PMR can literally appear overnight. People with the condition may go to bed feeling fine, only to awaken in pain the next morning.


Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin, others) can be effective in treating mild symptoms of PMR. But NSAIDs don't offer complete relief for many people, and long-term use can cause stomach and intestinal bleeding.

For that reason, the preferred treatment for PMR is a low, daily dose — usually 10 to 20 milligrams — of an oral corticosteroid drug such as prednisone (Deltasone, Meticorten). Relief should be almost immediate. If you're not feeling better in a few days, it's likely you don't have PMR. In fact, your response to medication is one way your doctor may confirm the diagnosis.

After the first month, when your sed rate and platelet count have dropped, and any anemia is improved, your doctor will gradually start lowering the amount of drug you take until you reach the lowest possible dosage needed to control inflammation. Some of your symptoms may return during this tapering-off period.

The amount of time on medication varies from person to person. Most people are able to discontinue steroids within 6 months to 2 years. It's important not to stop taking this medication on your own, however. Because corticosteroids suppress your body's natural production of hormones, stopping suddenly can make you very ill.

The power of corticosteroids
These powerful anti-inflammatory drugs mimic the effects of hormones produced by your adrenal glands. Corticosteroids taken in doses that exceed natural levels suppress inflammation. They're not the same as the anabolic steroids used by some athletes to increase strength and muscle mass. Anabolic steroids are chemically related to the male hormone testosterone rather than to adrenal hormones.

In the 1940s, cortisone — the first corticosteroid medication — was hailed as a miracle drug because it dramatically relieved pain for people with rheumatoid arthritis. But over time, it became apparent that the drug also caused serious side effects. Physicians now recognize that prolonged use of corticosteroids can lead to a number of problems.

Side effects of corticosteroids
Although anyone taking corticosteroids for long periods is likely to experience some side effects, older adults — those most likely to be treated for PMR — are particularly at risk. That's because they're more prone to develop certain conditions that also may be caused by corticosteroids, such as:

  • Osteoporosis. This condition causes bones to become so weak and brittle that even slight movements such as bending over, lifting a vacuum cleaner or coughing can cause a fracture. Older women are most at risk of osteoporosis, and taking steroid medications increases the risk. For this reason, your doctor is likely to monitor your bone density and may prescribe hormone replacement therapy or other medications to help prevent bone loss.

  • High blood pressure (hypertension). More than 50 million Americans, many of them older adults, have blood pressure too high for good health. Long-term corticosteroid use can also raise blood pressure. For that reason, your doctor is likely to monitor your blood pressure and may recommend an exercise program, diet changes and sometimes medication to keep blood pressure within a normal range.

  • Cataracts. Cortisone increases your risk of cataracts, a condition that causes the lens of the eye to become cloudy, impairing vision. About half of all Americans over age 65 have cataracts.

Other possible side effects of cortisone therapy include weight gain, decreased immune system function — making you more prone to infections — mood changes and high blood sugar levels, which may increase your risk of diabetes or worsen diabetes you already have.

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