Sometimes staying on the path to getting a medical diagnosis is more exhausting than battling the illness itself. Such is the case for many with a condition known as polymyalgia rheumatica (PMR). My husband went through a 13-month diagnostic nightmare before finding out he had PMR, a disease more often associated with women.
Overview
PMR is an inflammatory disorder sometimes mistaken as other conditions like rheumatoid arthritis. It causes muscle pain and stiffness. My husband was first diagnosed with Lyme disease, then rheumatoid arthritis. Despite taking medication for both conditions and eight months of narcotic pain killers, he didn’t improve.
Like many PMR patients, he is of Northern European origin. However, the average age of onset of this disorder is in the 70s. He’s in his 50s. Women are at least two times more likely to develop it than men.
Polymyalgia rheumatica is related to another serious condition, giant cell arteritis (GCA). This inflammation damages large- and medium-sized arteries that transport blood and nutrients from the heart to various parts of the body. Up to 30 percent of PMR patients develop GCA. Among those with giant cell arteritis, as many as half also suffer from PMR.
Symptoms and Causes
My husband awoke on a warm fall day in agonizing pain. He could not close his fists. His wedding ring, sized to go over his knuckle, normally rattled around on his finger but was now embedded in the flesh. His back, neck, shoulder, legs, and feet hurt almost unbearably, and he was so stiff he could barely stand.
His wrists didn’t want to bend. Over the next six months, he lost about 15 pounds despite eating normally. Five minutes after sitting down in front of the TV, he fell asleep.
Some patients have problems moving after being inactive for an extended period. Depression, a general malaise, and a mild or low-grade fever are signs of PMR.
My husband initially saw an internist. Repeated blood tests revealed nothing amiss. An inflammatory medication failed to help. The rheumatologist who then treated him suggested he had Lyme disease and a positive marker for rheumatoid arthritis.
Experts believe some patients are genetically predisposed to PMR. Another possible culprit is environmental exposure, such as a virus, though no specific virus had been identified.
Diagnosis and Treatment
Our family’s 13-month nightmare really began when the rheumatologist said my husband had Lyme disease, then said it might be a false positive and might also be causing a false reading of rheumatoid arthritis. My husband floundered for months, trying first one anti-inflammatory drug, then another. When one narcotic failed to control the pain, the doctor switched him to another one. He couldn’t even open the cap on a bottle of soda.
As he underwent several sets of blood tests, he continued to get worse. When he got to the point where he couldn’t put on a suit jacket, we started talking about the need to give up his job.
After eight months of treatment, my husband was sicker than the day he awoke in pain. We made the decision to consult a second rheumatologist, who began by repeating all the blood tests and ordering dozens of joint X-rays.
Since he doesn’t prescribe narcotics for any patient for longer than two weeks, we were faced with only a week of painkillers and the need to see a pain management specialist for more. My husband weaned himself off these drugs because he couldn’t get an appointment before he ran out of them.
Considering several physical exams, three sets of blood tests, and the X-rays, the second rheumatologist diagnosed PMR. Fortunately, there are no signs of GCA.
Though some relapse, most people with PMR recover. The standard treatment is corticosteroids like prednisone. My husband began to experience relief from stiffness after two days on them and now has no pain. He can once again tie his shoes.
He is slowly tapering the dosage to find the minimum that will keep pain at bay. We have been told that treatment for polymyalgia rheumatic can take one to as many as six years, depending upon a patient’s circumstances.
