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Polymyalgia Rheumatica

Disease Details

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Description: Polymyalgia rheumatica is an inflammatory disorder causing muscle pain and stiffness, primarily in the shoulders and hips.
Type: Polymyalgia rheumatica is an inflammatory disorder. It is not considered to be a hereditary disease, and therefore does not have a specific type of genetic transmission. The exact cause is unknown, but it is believed to involve a combination of genetic and environmental factors.
Signs And Symptoms: A wide range of symptoms can indicate if a person has polymyalgia rheumatica. The classic symptoms include:
Pain and stiffness (moderate to severe) in the neck, shoulders, upper arms, thighs, and hips, which inhibits activity, especially in the morning/after sleeping. Pain can also occur in the groin area and in the buttocks. The pain can be limited to one of these areas as well. It is a disease of the "girdles" meaning shoulder girdle or pelvic girdle.
Fatigue and lack of appetite (possibly leading to weight loss)
Anemia
An overall feeling of illness or flu-like symptoms.
Low-grade (mild) fever or abnormal temperature is sometimes present.
In most people, it is characterized by constant fatigue, weakness and sometimes exhaustion.
Night sweating
Weight loss
Swollen hands and feet because of retained moistureAbout 15% of people who are diagnosed with polymyalgia rheumatica also have temporal arteritis, and about 50% of people with temporal arteritis have polymyalgia rheumatica. Some symptoms of temporal arteritis include headaches, scalp tenderness, jaw or facial soreness, distorted vision, or aching in the limbs caused by decreased blood flow, and fatigue.
Prognosis: The prognosis for polymyalgia rheumatica (PMR) is generally favorable with appropriate treatment. Most individuals respond well to corticosteroids, which can significantly reduce symptoms such as pain and stiffness. However, the condition often requires long-term management, and some patients may experience relapses. Regular monitoring by a healthcare provider is important to adjust treatment and manage any potential side effects of medication.
Onset: Polymyalgia rheumatica is characterized by the sudden onset of muscle pain and stiffness, primarily in the shoulders, neck, and hips. The symptoms typically develop quickly over a few days or weeks and are most severe in the morning or after periods of inactivity. The condition mainly affects individuals over the age of 50.
Prevalence: The prevalence of polymyalgia rheumatica (PMR) varies by region and population. It is more common in people of Northern European descent and primarily affects individuals over the age of 50. Estimates suggest that PMR affects approximately 0.7% to 1% of people over 50, with higher rates in women than men.
Epidemiology: No circumstances are certain as to which an individual will get polymyalgia rheumatica, but a few factors show a relationship with the disorder:

Usually, PMR only affects adults over the age of 50.
The average age of a person who has PMR is about 70 years old.
Women are twice as likely to get PMR as men.
Caucasians are more likely to get this disease. It is more likely to affect people of Northern European origin; Scandinavians are especially vulnerable.
About 50% of people with temporal arteritis also have polymyalgia rheumatica.
Intractability: Polymyalgia rheumatica (PMR) is generally not considered intractable. It typically responds well to corticosteroid treatment, particularly prednisone, which can lead to rapid improvement of symptoms. However, long-term management may be necessary, and some patients may experience relapses or require prolonged treatment. Regular monitoring by a healthcare provider is essential to manage the condition effectively.
Disease Severity: Polymyalgia rheumatica is generally considered to be a serious but manageable condition. The severity of symptoms can vary, but it often causes significant discomfort and impaired daily functioning due to muscle pain and stiffness, primarily in the shoulders and hips. With appropriate treatment, typically involving corticosteroids, symptoms can be effectively controlled and patients can maintain a good quality of life.
Healthcare Professionals: Disease Ontology ID - DOID:853
Pathophysiology: Polymyalgia rheumatica (PMR) is an inflammatory disorder that primarily affects older adults. Its exact pathophysiology is not fully understood, but it is believed to involve an autoimmune component where the body's immune system attacks its own tissues, leading to inflammation. Key factors include:

1. **Immune System Dysfunction**: An aberrant immune response results in the production of pro-inflammatory cytokines, which play a central role in the inflammation seen in PMR.
2. **Genetic Predisposition**: There may be genetic factors that increase susceptibility to PMR, although specific genes have not been definitively identified.
3. **Environmental Triggers**: Infections and other environmental factors might trigger the onset in genetically predisposed individuals.

Inflammation predominantly affects the synovial linings of joints, bursae, and tendons, leading to symptoms such as shoulder and hip girdle pain and stiffness. Elevated markers of inflammation like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are commonly observed in patients with PMR.
Carrier Status: Polymyalgia rheumatica is not a hereditary disease, so there is no carrier status for this condition. It typically affects people over the age of 50 and is characterized by muscle pain and stiffness, particularly in the shoulders and hips. The exact cause of polymyalgia rheumatica is unknown, but it is believed to involve genetic and environmental factors.
Mechanism: Polymyalgia rheumatica (PMR) is an inflammatory disorder that primarily affects the muscles and joints. While the exact mechanism is not fully understood, it is believed to involve an abnormal immune response. Here are key points about its mechanism and molecular mechanisms:

**Mechanism:**
1. **Inflammation**: PMR is characterized by widespread inflammation, particularly in the shoulders, neck, and hip areas. The inflammation is thought to result from an immune system disturbance.
2. **Cytokines**: Elevated levels of pro-inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), are typically present. These cytokines promote inflammation and are involved in the clinical symptoms.
3. **Immune Cells**: Increased activity and infiltration of immune cells like macrophages and T-cells in the affected tissues drive the inflammatory process.

**Molecular Mechanisms:**
1. **Cytokine Pathways**: IL-6 and TNF-α play a significant role in the increased acute-phase reactants, like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), which are hallmarks of PMR.
2. **Genetic Factors**: Specific genetic predispositions, including HLA-DRB1 alleles, have been associated with higher susceptibility to PMR, suggesting a genetic component in its pathogenesis.
3. **Cell Signaling**: Abnormal signaling through pathways involving nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and Janus kinase (JAK)-STAT can amplify inflammatory responses.
4. **Autoimmunity**: There may be an autoantigen that triggers self-reactive immune responses, although a specific autoantigen has not been definitively identified in PMR.
5. **Age-Related Changes**: Since PMR primarily affects older adults, age-related changes in the immune system (immunosenescence) likely contribute to its development.

Understanding these mechanisms provides valuable insights into potential therapeutic targets, primarily focusing on reducing inflammation and modulating immune responses. Treatment typically involves corticosteroids to manage symptoms and inflammation.
Treatment: Prednisone is the drug of choice for PMR, and treatment duration is frequently greater than one year. If the patient does not experience dramatic improvement after three days of 10–20 mg oral prednisone per day, the diagnosis should be reconsidered. Sometimes relief of symptoms occurs in only several hours.Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are ineffective in the initial treatment of PMR, but they may be used in conjunction with the maintenance dose of corticosteroid.Along with medical treatment, patients are encouraged to exercise and eat healthily, helping to maintain a strong immune system and build strong muscles and bones. A diet of fruits, vegetables, whole grains, and low-fat meat and dairy products, avoiding foods with high levels of refined sugars and salt is recommended. Research in the UK has also suggested that people with polymyalgia rheumatica would benefit from a falls assessment when first diagnosed, and regular treatment reviews.
Compassionate Use Treatment: For polymyalgia rheumatica (PMR), compassionate use treatment and off-label or experimental treatments are generally considered when conventional treatments are not suitable or ineffective. Here are a few options:

1. **Biologic agents**: Although not formally approved for PMR, biologics such as tocilizumab (an IL-6 receptor antagonist) have been used off-label with some success, particularly in cases refractory to standard treatment.

2. **Methotrexate**: Often used as a steroid-sparing agent, methotrexate is sometimes prescribed off-label to help reduce the need for long-term corticosteroid use and manage symptoms.

3. **JAK inhibitors**: Medications like tofacitinib, typically used for other inflammatory conditions, are being investigated for PMR in experimental settings.

4. **Abatacept**: Another biologic agent, abatacept, which modulates immune response, has shown promise in clinical trials and case reports for PMR management.

These treatments should be considered carefully and discussed with a healthcare provider, as they carry potential risks and benefits particularly specific to each patient's condition.
Lifestyle Recommendations: For polymyalgia rheumatica, the following lifestyle recommendations can help manage symptoms and improve quality of life:

1. **Regular Physical Activity:** Engage in low-impact exercises such as walking, swimming, or stretching to maintain joint flexibility and overall health.
2. **Balanced Diet:** Eat a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats to support overall health and reduce inflammation.
3. **Adequate Rest:** Ensure you are getting sufficient sleep and rest to help your body recover and manage fatigue.
4. **Weight Management:** Maintain a healthy weight to reduce stress on your joints.
5. **Stress Management:** Practice stress-reducing techniques such as yoga, meditation, or deep-breathing exercises to help manage pain and inflammation.
6. **Regular Medical Check-ups:** Keep up with routine medical appointments to monitor the condition and adjust treatments as necessary.
7. **Hydration:** Stay well-hydrated to support overall bodily functions and joint health.
8. **Avoid Smoking and Limit Alcohol:** Smoking can increase inflammation and interfere with medication effectiveness, while excessive alcohol can lead to other health issues.

These lifestyle changes, combined with medical treatment, may help manage the symptoms of polymyalgia rheumatica more effectively.
Medication: Polymyalgia rheumatica (PMR) is primarily treated with corticosteroids, most commonly prednisone. The initial dose often starts between 12.5 to 25 mg per day, depending on the severity of symptoms. Once symptoms improve, the dose is gradually tapered to the lowest effective amount. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to manage mild symptoms, though they are generally less effective than corticosteroids. Regular monitoring and follow-up with a healthcare provider are essential to adjust treatment and manage potential side effects.
Repurposable Drugs: Polymyalgia rheumatica (PMR) is primarily treated with corticosteroids, such as prednisone. Repurposable drugs that have shown some potential in managing PMR symptoms include methotrexate and tocilizumab. Methotrexate is an immunosuppressant often used in rheumatoid arthritis, while tocilizumab is an anti-interleukin-6 receptor monoclonal antibody also used in rheumatoid arthritis and giant cell arteritis.
Metabolites: Polymyalgia rheumatica (PMR) is an inflammatory disorder that primarily affects older adults. Metabolites specifically associated with PMR are not distinctly identified. However, research has shown that inflammatory markers like elevated levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are commonly associated with the disease.

If you need information on a specific metabolite related to PMR, further specific scientific studies might be required to identify any unique biomarkers related to its metabolic profile.
Nutraceuticals: There is limited evidence on the effectiveness of nutraceuticals in the treatment of polymyalgia rheumatica (PMR). Management primarily involves the use of corticosteroids to reduce inflammation and suppress the immune system. However, some general anti-inflammatory and immune-supportive nutraceuticals, such as omega-3 fatty acids, vitamin D, and curcumin, may have ancillary benefits. Always consult a healthcare provider before starting any new supplement regimen.
Peptides: Polymyalgia rheumatica (PMR) is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders. It primarily affects older adults. There isn't specific information linking peptides to the treatment or pathology of PMR. Conventional treatment usually involves corticosteroids to reduce inflammation. Nanotechnology or nanoparticles in the context of PMR treatment is still an emerging area of research and has not yet become a standard treatment approach.