04/20/2010 - Articles

Dealing with polymyalgia

By: Susan Aldridge, medical journalist, PhD

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Polymyalgia rheumatica is one of the most common chronic conditions affecting older people. Typically, polymyalgia involves pain and stiffness of acute onset in the shoulder, hip, neck and torso. Many other conditions are similar to polymyalgia, so diagnosis can be tricky. Around 700 people per 100,000 of the population have polymyalgia in the over-50s age group.

Polymyalgia is one of the most common reasons for long term steroid use, accounting for around a quarter of all prescriptions. Yet, even though it is clearly such an important health issue, there is little clinical trial evidence on polymyalgia to guide its management. Which is why new guidelines on polymyalgia from the British Society for Rheumatology and the British Health Professionals for Rheumatology are welcome and will, hopefully, help doctors and patients alike.

On diagnosis, the guidelines say polymyalgia is likely if the patient is over 50, has had symptoms for more than two weeks, complains of aching in the shoulders or hips, and has morning stiffness that goes on for more than 45 minutes.

Suggested treatment is prednisolone, a steroid, 15 milligrams for three weeks which is then reduced but may continue for one to two years. This should lead to a 70% or so reduction in polymyalgia symptoms. If there is no response, then maybe the problem is not polymyalgia. However, remember, there have been few clinical trials so evidence that prednisolone is the right solution is limited.

When should you seek specialist help? Discussing the new guidelines, UK experts Eleana Ntatsaki and Richard Watts say that lack of involvement of the shoulder and symptoms like night pain or weight loss are ‘red flags’ that need further investigation. A more chronic onset of apparent polymyalgia is another ‘red flag’ as is occurrence of symptoms in a younger person. There are no other guidelines on polymyalgia at the moment but the new ones from the UK are a useful start and will hopefully stimulate further research into this common and painful condition.

 

Source:

Ntatsaki E and Watts RA Management of polymyalgia rheumatic British Medical Journal 27th February 2010;340:435

 

Created on: 04/20/2010
Reviewed on: 04/20/2010

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