Rheumatic polymyalgia treatment without hormones. Polymyalgia rheumatica - causes, symptoms, diagnosis, treatment and recommendations

- pains of a rheumatic nature, simultaneously occurring in different muscle groups. Polymyalgia rheumatica is characterized by muscle pain and stiffness that is more pronounced in the morning and improves during the day; pains are usually localized in the muscles of the neck, shoulders, spine, hips, buttocks. Polymyalgia rheumatica mainly affects women over 50 years of age. There is no specific diagnosis of polymyalgia rheumatica; the disease is recognized on the basis of clinical and laboratory signs. Treatment includes NSAIDs, corticosteroids, and chemotherapy. The course of polymyalgia rheumatica is benign, with treatment the disease is safely resolved.

ICD-10

M35.3

General information

The etiological factors of polymyalgia rheumatica are unknown. Obviously, the leading role of violations in the immune sphere and heredity, the starting role of sensitizing and infectious (adenovirus, parainfluenza virus) agents is discussed. Giant cell temporal arteritis (Horton's disease) can provoke and maintain the course of polymyalgia rheumatica.

Symptoms of polymyalgia rheumatica

The onset of polymyalgia rheumatica is acute - with fever and severe intoxication. Against this background, multiple myalgias develop in the area of ​​the shoulder girdle, neck, hips, buttocks. Muscular pain in the distal extremities is usually not typical, except in cases of concomitant arthritis, arthrosis, or arteritis.

The severity of myalgia is intense, the character is pulling, pulling or cutting. The pain is always present, aggravated in the morning and after a long absence of movement; during these periods, muscle stiffness is noted. Myalgias are expressed not only in the process of performing voluntary movements, but also in muscles that are under static load, so patients are forced to constantly change their posture or body position. Polymyalgia rheumatica is not associated with a change in weather conditions, its intensity does not change significantly under the influence of cold or heat factors.

Muscle pains force you to limit movements (especially active ones) in the cervical spine, shoulder girdle, and hip joints. Elementary actions become difficult: raising the head in a prone position, turning in bed, squatting, getting up from a chair, walking up flights of stairs, dressing, combing hair. With rheumatic myalgia, the patient develops a characteristic mincing gait with frequent short steps.

The clinic of polymyalgia rheumatica reaches its peak 1-2 months after the onset of initial symptoms. During this period, the pain can become so intense and excruciating that it entails complete immobilization of the patient. Palpation of the muscles concerned in polymyalgia rheumatica does not reveal any special changes - hyperthermia, induration, increased soreness, muscle atony and atrophy. Patients are still worried about fever, anorexia, weight loss, weakness.

The clinic of polymyalgia rheumatica can occur with symptoms of true arthritis, which usually develops a few months after myalgia. Large joints are more often involved in arthritis, sometimes an effusion forms in the joint cavity; the pains are moderately pronounced and unstable. With the interest of small joints of the hand, moderate diffuse edema is observed with the development of carpal tunnel syndrome, tendovaginitis and flexion contracture of the fingers.

Diagnosis of polymyalgia rheumatica

The diagnosis and treatment of polymyalgia rheumatica is handled by a rheumatologist. Specific changes in the peripheral blood in polymyalgia rheumatica are not detected; only moderate anemia and an increase in ESR are detected. When researching venous blood on biochemistry, there is an increase in CRP with negative laboratory tests for RF and LE cells.

Radiographically, erosions, a decrease in the width of the joint space are extremely rarely detected; in elderly patients - the phenomenon of osteoarthritis. Ultrasound of the joint and tomographic (MRI, PET) diagnostics in polymyalgia rheumatica confirm inflammatory changes. Microscopic examination of the synovial fluid reveals the presence of neutrophilic leukocytosis. Examination of a biopsy specimen of the synovial membrane reveals signs of mild nonspecific synovitis. Muscle biopsy in polymyalgia rheumatica is not informative.

Treatment and prognosis of polymyalgia rheumatica

Polymyalgia rheumatica, not associated with giant cell arteritis, is benign and resolves in 50–75% of patients within 3 years. Lack of medical supervision and treatment of polymyalgia rheumatica leads to limb deformity and disability. Prevention of polymyalgia rheumatica has not been developed.

One of the most common systemic pathologies of the musculoskeletal system that affects a person with age is polymyalgia rheumatica. According to statistics, it occurs in about one person out of a thousand. The disease is characterized by the occurrence of rheumatic pains in different muscle groups, as well as severe stiffness in movements. Symptoms are more pronounced in the morning, disappear in the evening, but may be aggravated by exercise. Doctors do not yet have a clear answer to the question of why this happens, and there is also no specific diagnosis of the disease. The diagnosis is made on the basis of the patient's complaints and blood tests, which reveal signs of the inflammatory process. It is characteristic of the disease that it can be treated mainly with corticosteroid hormones.

Polymyalgia rheumatica occurs most often in people over 50 years of age. Mostly women are affected. Interestingly, the disease is more often recorded in the countries of Northern Europe.

A feature of the pathology is that pain affects several muscle groups at the same time, pain occurs symmetrically, but does not appear in the limbs below the elbow and knee joints. It is also characteristic of her that mainly physically strong people who do not have serious chronic pathologies fall ill.

The disease does not pose a big threat to life, but it greatly reduces the efficiency and worsens the mental state of the patient. The patient needs to prepare for long-term treatment, without which the disease becomes chronic and can cause complications.

Causes

Doctors have been studying the disease for about 50 years. But it is still unclear what causes these symptoms. Most often, researchers associate the development of polymyalgia rheumatica with bacterial or viral infection, since the first symptoms often appear after the flu or acute respiratory infections. Many patients are diagnosed with giant cell temporal arteritis, so this disease can also be considered a trigger for pathology. But the occurrence of rheumatic polymyalia can also provoke such reasons:

• severe stress;
• hypothermia;
• frequent colds;
• severe flu or adenovirus infection;
• hereditary pathologies immune system;
• rheumatoid arthritis or other inflammatory joint diseases.

Polymyalgia rheumatica most often occurs in elderly patients after suffering infectious diseases or stress

Symptoms

Symptoms of polymyalgia rheumatica are quite pronounced, but can often be mistaken for other diseases. After all, the main manifestation of the disease is severe muscle pain in the spine, shoulder and hip joints. Therefore, the patient is often treated for a long time for arthritis, arthrosis or osteochondrosis. But in fact, the joints are not affected, as indicated by their examination. Only a thorough diagnosis and monitoring of the course of the disease allows the doctor to make a correct diagnosis.

The disease usually begins suddenly, and proceeds acutely. A fever develops, against the background of which pains in the muscles of the pelvic region, back, shoulders, and neck are strongly expressed. Sensations are most often strong, patients characterize them as jerking or cutting pains. But their peculiarity is that they are strongly expressed in the mornings, as well as during physical activity. Moreover, muscles are affected not only during movement, but also after prolonged immobility. Therefore, patients must constantly change the position of the body in order to avoid painful sensations. If the patient finds a comfortable position and is at rest, the pain does not bother him.

In addition to pain, with polymyalgia rheumatica, there is severe stiffness and weakness in the muscles. For patients, it becomes difficult to perform habitual movements. It is especially difficult to squat, get up from a chair or bed, go down the stairs, dress, comb your hair. Such patients are characterized by a specific gait with small steps.

The main symptom of the disease is severe pain in the shoulder girdle or in the pelvic area.

Approximately 1-2 months after the onset of the disease, pain and stiffness in the muscles increase, often leading to complete immobility of the patient. Due to weakness and soreness, patients cannot move independently. In addition, other signs of pathology begin to appear:

• stiffness and hypotension of muscles;
• chronic fatigue, severe weakness;
• loss of appetite;
• weight loss, anemia;
• tachycardia;
• increased sweating, chilliness;
• deterioration in mood, depression, depression;
• sleep disorders.

Diagnostics

Often, patients are misdiagnosed for a long time. After all, the main manifestation of the disease is pain, which is characteristic of many pathologies. Usually, when examining a patient, no changes in the muscles are found: they are not painful on palpation, there are no infiltrates, seals or hyperthermia. But an experienced doctor can see the specific symptoms of the disease. This is the symmetry of pain, damage to the muscles above the knee and elbow joints, severe weakness, lack of swelling.

In addition to identifying symptoms characteristic of the disease, the diagnosis of polymyalgia rheumatica includes blood tests. They show specific markers of inflammation, elevated ESR, and anemia. Consideration of such signs in the complex allows the doctor to correctly diagnose.

But additional methods of examination are also needed to exclude diseases that cause the same symptoms. This malignant tumors v digestive system or lungs, myeloma, rheumatoid arthritis, dermatomyositis, periarthritis.

The disease is difficult to detect, as its symptoms resemble many other diseases.

Complications

If the correct diagnosis is not made in time, polymyalgia rheumatica progresses and can cause complications. Most often it is an inflammatory lesion of the joints. Synovitis, bursitis or arthritis develops. Shoulder, knee and wrist joints are most susceptible to inflammation, and deformities bone tissue are absent, and after the treatment of the underlying disease, the inflammation disappears. Sometimes carpal tunnel syndrome also develops, which is expressed in weakness and numbness of the muscles of the hand.

A common complication of the disease is giant cell temporal arteritis, a lesion of the temporal artery, leading to severe headaches and visual impairment. This pathology is also called Horton's disease after the doctor who first described it. Since the two diseases occur together so often, many doctors consider Horton's disease to be the cause of polymyalgia rheumatica, although it sometimes develops some time after the onset of muscle pain. But in any case, treatment should be started as early as possible. After all, temporal arteritis can lead to loss of vision, cause the development of myocardial infarction.

If the treatment of the disease with steroid hormones is started on time, complications can be avoided. In this case, after 2-3 years, the patient fully recovers. Usually, with adequate therapy, the disease does not leave consequences and passes without a trace.

Treatment

Polymyalgia rheumatica can be treated with glucocorticosteroids. The appointment of non-steroidal anti-inflammatory drugs in most cases is ineffective, since it does not relieve inflammation. Only with moderate symptoms and early treatment can this be justified. Indomethacin, Ortofen, Ketanov work best. They may also be prescribed in addition to hormone therapy with severe pain syndrome.

But most effective treatment are glucocorticosteroids. Most often, low doses of Prednisolone are used - up to 30 mg per day. This dose should be divided into 2-4 times depending on the severity of the course. But you need to take it regularly for at least 8 months. Sometimes hormone therapy lasts 1-2 years. Despite the fact that the patient feels relief after a few days, you need to drink the medicine until the moment when not only the pain sensations decrease, but also the tests improve. After that, the dose is gradually reduced to 5-10 mg per day with constant monitoring of blood counts.

The main drug for the treatment of polymyalgia rheumatica is Prednisolone, the dosage of which is determined individually.

Such maintenance therapy should be continued for several months after improvement. If treatment is stopped earlier, the disease can become chronic. Therefore, it is very important to individually, under the supervision of a physician, slowly reduce the dosage of Prednisolone, and take it for a long time.

Glucocorticosteroids often cause side effects, so it is important to constantly monitor the doctor and prescribe additional drugs to prevent complications. Most often, these are drugs or nutritional supplements containing calcium and vitamin D3. Medicines are also needed to prevent hypoglycemia, stomach ulcers, and cataracts. In addition, immunostimulants and vitamins are sometimes prescribed as maintenance therapy. Recently, the drug "Metipred" is considered effective, which helps to avoid complications.

Good results were shown by the combination of "Prednisolone" with "Methotrexate". This allows you to reduce the dosage of hormones without reducing efficiency. This therapy has less side effects. Additionally, alternative treatment can also be used to relieve pain and improve well-being. But any remedy can be used only after consulting a doctor.

In addition, the success of treatment is highly dependent on the lifestyle of the patient. He needs to give up bad habits, be sure to perform a special complex of physiotherapy exercises and follow a diet. Nutrition should be balanced, provide the body with all the necessary vitamins and minerals. It is recommended to exclude fatty and canned foods, limit salt intake.

To restore mobility and muscle tone, the patient is shown physiotherapy exercises

Alternative treatment

Official medicine this disease is known recently. But in traditional medicine considerable experience has been accumulated in the treatment of inflammatory diseases of the joints and muscles. Using such recipes, you can relieve pain and alleviate the patient's condition. Sometimes even doctors recommend trying treatment in addition to the prescribed therapy. folk remedies. There are many recipes that use medicinal herbs and substances available to everyone.

• Effectively relieve pain compresses from young birch leaves. They need to be scalded with boiling water so that they soften, and applied to sore muscles. Top cover with foil and insulate. Such a compress should be done before going to bed for a week.
• Independently from inexpensive available drugs, you can make a tincture for rubbing sore muscles. To do this, grind 10 tablets of "Analgin". Pour them with 300 ml of alcohol. Add there 10 ml of camphor alcohol and iodine. Keep the tincture for 3 weeks in a dark place.
• Inside, you can take a tincture of juniper fruits. It is made from a glass of vodka and a tablespoon of fruit. You need to drink tincture in a teaspoon 2 times a day for at least 2 months.
• The same duration of treatment for taking a decoction of corn stigmas. To prepare it, a teaspoon of raw materials is poured into a glass of water and boiled for 10-15 minutes. You need to drink a third of a glass a day.
• Effectively helps relieve pain in polymyalgia rheumatica bath from hay dust. Take 800 g of grass, place in a cotton or linen bag and boil in 2 liters of water. The broth is poured into the bath. The procedure is carried out with hot water in addition, you need to cover the bath with a thick cloth so that the esters of plants do not evaporate. Therefore, such treatment is not indicated for everyone.

Polymyalgia rheumatica is not a dangerous disease, but rather painful for the patient. It is very important to make a diagnosis on time and take the medicines prescribed by the doctor regularly. After all, without proper treatment the disease will become chronic, then it will be much more difficult to cope with it.

The causes of this disease are still being studied, and experts do not have a clear answer why polymyalgia rheumatoid appears. Now much is known about this disease, including effective methods of treatment. Despite the fact that folk remedies and home treatment does not differ in efficiency, a course of special medications will help get rid of the disease.

The risk group for the occurrence of polymyalgia rheumatica, its symptoms and treatment are discussed in our article.

Polymyalgia rheumatica usually occurs spontaneously in patients over 50 years of age, predominantly in women. It is manifested by pains of different intensity in the muscles of different departments. The disease begins with a feeling of stiffness of movement, the inability to perform the usual actions. Pain and numbness of the muscles appear in the first half of the day, after a long period of inactivity.

The mechanism of development of pathology

The etiological factors in the development of this disease are not known for certain. Allocate patients from the risk group, which can be grouped by gender and age, as well as by region of residence. In addition, the formation of pathology can occur under the influence of weakened immunity, as well as genetic predisposition.

The development of the disease is influenced by external factors, especially the already diagnosed Horton's disease. With this disease, an inflammatory process occurs in large vessels. For a more precise definition possible pathology a temporal artery biopsy may be needed.

By the way, the risk group for Horton's disease is the same as among patients with polymyalgia rheumatica.

Who is more likely to get this disease:

1. People over 50. The peak incidence occurs at the age of 65-75 years;
2. Women. There are about three male patients for every five female patients;
3. Inhabitants of the Scandinavian countries. The incidence rate in the population of northern Europe is 15-35 people / 100,000 population. For comparison, this figure in Asian countries is only 1.47;
4. Patients with a genetic predisposition. If similar rheumatoid diseases were encountered in the family, the risk of getting sick increases dramatically.

Effective methods for the prevention of this disease have not been identified. It is believed that the right lifestyle and a complete diet reduces the risk of getting sick, but this statement is based more on the overall strengthening of the body, as well as increasing immunity.

According to one of the scientific theories, polymyalgia rheumatica, the symptoms of which are discussed below, occurs after the negative effects of viruses and infections on the body. As a result of such exposure, an atypical autoimmune reaction of the body is provoked, leading to damage to its own tissues and organs.

Symptoms of the disease

The manifestations of polymyalgia rheumatica are quite diverse, so the symptoms are similar to other diseases. It is not always possible to accurately diagnose

Diagnostic methods

There is no specific method for recognizing the disease. It is known that when making a diagnosis, blood samples and synovial fluid are examined. An important role is also played by a personal examination and questioning of the patient. Polymyalgia, the symptoms and treatment of which requires qualified assistance from a rheumatologist, is carried out in several stages, the very first of which is the correct diagnosis.

The assumption of the development of polymyalgia is made on the basis of the following data:

• The patient is over 50 years old. It is also necessary to study the patient's medical history to identify other possible causes symptoms;
• The presence of regular pain in at least three different parts of the muscles for more than two months. This is the cervical, shoulder and pelvic girdle;
• Symmetrical manifestation of discomfort. The presence of pain on only one side of the body may indicate an injury or other disease;
• The patient has a disorder of attention, increased fatigue and irritability, general weakness and involuntary weight loss;
• Laboratory blood tests show the development of anemia, as well as an ESR increased to 35 mm / h;
• Holding special analyzes synovial fluid shows the presence of protein and leukocytes, as well as changes in connective tissue.

Despite the fact that in most cases polymyalgia rheumatoid has ambiguous symptoms, a latent course of the disease is also possible. In such situations, data can be obtained only with negative laboratory tests, as well as objective complaints of fatigue, nervousness, and lack of the necessary concentration of consciousness. Usually, diagnosis involves the exclusion of other possible diseases that have similar symptoms.

Treatment of polymyalgia rheumatica

In most cases, complete relief from the disease is possible only after a long course of specially selected medications. Polymyalgia rheumatica, which is not treated with folk remedies, involves a long struggle, but with a high chance of success.

It should be noted that in about 10% of cases spontaneous cure was recorded. This can be achieved by methods of physical rehabilitation, as well as the use of immuno-strengthening and health-improving agents.

In addition, it is desirable to radically change the way of life, throw off excess weight and increase physical activity.

The following treatment algorithm showed the greatest efficiency:

1. Oral glucocorticoids in an individually selected dosage. The most commonly used prednisolone and its analogues. In cases where the effect of treatment is noticeable already three to four weeks after taking the funds, the dosage is gradually reduced. The full course is several months, can last up to two years.
2. Non-steroidal anti-inflammatory drugs are used in extreme cases. Usually the effect of them is not so significant, so they are not used in complex therapy.
3. Preparations containing methotrexate belong to the group of cytostatics. Used when not effective hormonal treatment. Reception is carried out in conjunction with glucocorticoids.
4. Complex preparations of vitamins and calcium. Used to reduce the risk of side effects after taking steroid medications. It is especially important during the treatment period to prevent bone loss and loss of vitamin D.
5. Physiotherapy methods are often used in complex treatment after the removal of the symptoms of the acute period. It can be massage, special exercises and manual therapy methods. The choice of a suitable technique must be agreed with the attending physician.

It should be noted that self-cancellation of drugs, as well as violation of recommendations and dosages, can lead to a relapse of the disease. In this case, treatment must be resumed, but with the use of stronger drugs. That is why, hormone-free treatment of polymyalgia rheumatica is used infrequently, as a therapy with less chance of success.

Treatment without hormones for polymyalgia rheumatica necessarily includes lifestyle changes, the use of assistive devices for lifting and moving weights. In addition, you should choose comfortable shoes and clothes, review the diet and quality of food, get plenty of rest and be outdoors.

Polymyalgia rheumatoid, the symptoms and treatment of which are discussed in our article, occurs most often in elderly patients, mainly in women.

The mechanism of development of pathology is not fully understood and includes many negative factors. For example, it has been proven that the inhabitants of the Scandinavian countries have a genetic predisposition to such diseases.

Despite insufficient information about the causes of occurrence, the treatment of polymyalgia rheumatica is quite successful, and in some cases it is possible to use physiological manipulations, as well as alternative recipes.

Has proven to be the most effective drug therapy, including long-term use of individually calculated doses of corticosteroids. Features of the treatment of polymyalgia rheumatica, as well as the main diagnostic methods are discussed in the information of our article.

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. Is it possible to get rid of polymyalgia permanently? Are there really effective treatments? What complications can the disease lead to? This information will be useful to many readers.

What is a disease?

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

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

Epidemiology of the disease

In fact, such muscle diseases are diagnosed not so 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 younger than 50 years old are considered an incredible rarity - most often people over 60 years of age get sick. Interestingly, among women, this pathology is diagnosed approximately twice as often as 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 far from 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 provoke the development of the disease. In particular, various infections can be attributed to the list of causes - adenoviruses, parainfluenza viruses and some other pathogens are considered the most dangerous. In addition, it has been proven that Horton's disease, giant cell temporal arteritis, can start the autoimmune process.

Naturally, gender can also be attributed to risk factors (women get sick more often), elderly 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. Immediately it should be said that this form of polymyalgia develops abruptly - the signs 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 note 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 understands that pain is the main symptom. Of course, in such cases, the patient is interested in what caused such intense pain in the muscles. The reasons may lie precisely in the development of the rheumatic form of polymyalgia.

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

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

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

How to recognize the disease?

Unfortunately, today there are no exact criteria for diagnosis. However, in medicine it is customary to consider the presence of polymyalgia rheumatica if:

• the age of the patient is more than 60-65 years;
• during clinical analyzes observed - up to 40 mm / h or 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 their severity is constantly increasing;
• 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 improves rapidly.

To make a 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 appropriate tests, and also check compliance with the international criteria scale.

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

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

Medical methods of treatment

To date, the only truly effective method elimination of 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 drugs for 1-2 years. If you stop treatment too early or reduce the dose of hormones, you can provoke a new exacerbation of the disease.

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

Since long-term hormone therapy can provoke osteoporosis, as a preventive measure, patients are prescribed nutritional 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 pain brings discomfort to a person’s life, but they are not a direct threat. However, the disease can cause 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 severe pain in the temples, which are worse at night. It is also possible to weaken vision, up to its loss (most often the eye from the side of the affected artery suffers). If left untreated, temporal arthritis can lead to myocardial infarction.

Is it possible to treat the disease with folk remedies?

Of course, patients are wondering if there are home remedies that can get rid of a problem like polymyalgia rheumatica. Treatment with folk remedies, of course, is possible. For example, young birch leaves are considered quite effective. First you need to pour boiling water over them and let them soften. After that, the leaves should be applied to the affected areas of the muscles, covered with compress paper on top and wrapped with 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 tincture of mullein with vodka (applied externally) will also help eliminate soreness. It is these methods that are used to eliminate the disease called polymyalgia rheumatica. Treatment, however, cannot replace hormone therapy. Home remedies can only be used as ancillary methods and only with the permission of the attending physician.

Diet for polymyalgia rheumatica

It is immediately worth noting that polymyalgia rheumatica requires some dietary restrictions. The fact is that pain is significantly aggravated in the presence of obesity. Moreover, one of the side effects of hormone therapy is fast growth body fat mass.

Naturally, you should not strictly limit yourself in nutrition - the body must receive enough 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. It is not recommended to abuse alcohol. At the same time, fresh fruits and vegetables, lean, steamed meats, as well as cereals and dairy products will help provide the body with all the necessary nutrients. It is very important to include calcium-rich foods in your diet, as daily rate of this mineral against the background of hormone 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 chances of patients to recover? To begin with, it is worth noting that medicine knows cases of spontaneous extinction of the disease - such a phenomenon is rare, but still possible. Moreover, in most cases, with properly selected hormonal therapy and compliance with all precautions, complete recovery occurs over time.

And here is the rejection drug treatment or advanced form of the disease is fraught with negative consequences. In some patients, polymyalgia rheumatica becomes chronic - this form is characterized by an undulating course with regular occurrence of exacerbations.

Rheumatic polymyalgia - inflammatory disease of the musculoskeletal system, developing only in the second half of a person's life, characterized by severe pain of stereotypical localization (neck, shoulder and pelvic girdle), movement disorders, a significant increase in laboratory parameters of inflammation, as well as the onset of remission when glucocorticoids are prescribed in small doses. Polymyalgia rheumatica is often combined with giant cell (temporal) arteritis (Horton's disease).

ICD-10 code

M35.3 Polymyalgia rheumatica

Epidemiology

The frequency of diagnosis of new cases of polymyalgia rheumatica per year in different countries ranges from 4.9 to 11.1 per 100 thousand of all residents (from 12.7 to 68.3 per the same number of residents aged 50 years and older). A trend towards a lower prevalence of the disease in countries located closer to the equator was noted. People younger than 50 years of age do not develop polymyalgia rheumatica. The peak incidence is observed after 60 years. Women are approximately twice as likely to be affected

Polymyalgia rheumatica: symptoms

Rheumatic polymyalgia in most cases develops acutely, complete clinical picture("peak disease") is formed in 2-4 weeks. There are severe pains covering the neck, shoulder joints and shoulders, hip joints and hips. Pain in the region of the shoulder and pelvic girdle is bilateral and symmetrical, constant, aggravated by movement. At rest, the pain temporarily decreases, but occurs with each change in body position. Because of this, sleep is drastically disturbed. Stiffness is typical, most pronounced in the morning after sleep or any long period of immobility.

A constant sign of polymyalgia rheumatica is the restriction of movements in the shoulder, hip joints, as well as in the neck. Due to pain, the patient's ability to self-service is significantly impaired (it is difficult for the patient to comb his hair, wash, dress, lift and hold something with his hands, sit on a low seat and get up from it), as well as the ability to move. In some cases, patients are forced to spend most of their time in bed. Reception of analgesics and NSAIDs does not have a significant effect on the condition of patients.

A number of patients develop mild arthritis of the wrist, knee, clavicular-acromial joints and, very rarely, small joints of the hands or feet. As a rule, inflammation develops in no more than three joints, the damage is not symmetrical. Pain in the affected joints is usually small: they are much less than in the shoulder and pelvic girdle.

Some patients develop a mild carpal tunnel syndrome with a typical symptom - numbness in the tips of the fingers I-IV of the hands, and sometimes palmar fasciitis, causing moderate swelling of the hand, the formation of flexion contractures of the fingers, thickening and soreness of the palmar fascia and finger flexor tendons.

Often there is a fever, usually subfebrile, but sometimes reaching up to 48 C and above. It never precedes typical pain sensations, but usually joins in their height, leading to a more severe condition of patients. In many cases, body weight decreases quite quickly, sometimes significantly, which is usually accompanied by loss of appetite. Characterized by general weakness, low mood.

Patients with polymyalgia rheumatica may have overt or covert signs. giant cell arteritis. In any case, it is necessary to purposefully look for these signs, since the presence of arteritis determines the course and requires the immediate appointment of a significantly higher dose of glucocorticosteroids than in "isolated" polymyalgia rheumatica.

How is polymyalgia rheumatica diagnosed?

The development of polymyalgia rheumatica should be suspected in an elderly person (previously, as a rule, did not suffer from rheumatic diseases) with a sudden, without apparent reason emerging severe pain in the shoulder, hip joints and neck, accompanied by movement disorders, as well as non-specific symptoms (weakness, subfebrile condition, loss of appetite) and a significant increase in laboratory parameters of inflammation (ESR and CRP). The diagnosis of polymyalgia rheumatica is possible only after the exclusion of other diseases that occur with similar clinical and laboratory signs (oncopathology, rheumatoid arthritis, etc.).

There are no generally accepted criteria for the diagnosis of polymyalgia rheumatica. At the European Congress of Rheumatology (Prague, 2001), it was recommended to use the diagnostic signs of the disease proposed by H.A. Bird, in combination with an additional criterion - a rapid improvement in the condition after the start of taking glucocorticosteroids. These signs include:

• the age of the patient at the onset of the disease is over 65 years;
• increase in ESR (more than 40 mm/h);
• bilateral pain of a symmetrical nature in the area of ​​the shoulder and pelvic girdle;
• morning stiffness lasting more than 1 hour;
• duration of symptoms more than 2 weeks:
• an increase in the number and severity clinical symptoms within 2 weeks:
• depression and/or weight loss:
• rapid and significant effect of prednisolone in daily dose no more than 15 mg per day.

For the diagnosis of polymyalgia rheumatica, all of the above signs are required (sensitivity 99%).

When making a diagnosis, it is important to evaluate the result of the use of glucocorticoids. In almost all patients within 3-6 days after daily intake Prednisolone (usually at a dose of 15 mg / day) radically improves the condition, normalizes ESR and other laboratory indicators of inflammation. In this regard, patients must be examined after the appointment of prednisolone. The absence of the expected positive dynamics may indicate an erroneous diagnosis

Activity score

A simplified disease activity index (simplified disease activity index polymyalgia rheumatic - SDAI PMR) is used to assess disease activity, achieve remission and the adequacy of ongoing therapy.

Intensity pain syndrome calculated by VAS and evaluated by the patient and the researcher. The duration of morning stiffness is measured by the patient in minutes from the moment of awakening. The level of elevation of the upper limbs is calculated from 0 to 180 and is divided into 3 degrees depending on the obtained indicators.

Polymyalgia rheumatica activity index score:

• low - less than 7:
• average - 7-17;
• high - more than 17.

Data from additional research methods

V clinical analysis blood in all patients from the first days of the disease, ESR is sharply increased by 40 mm / h or more, hypochromic anemia is often noted. A biochemical study reveals an increase in the concentration of CRP, a slight increase in the activity of transaminases and alkaline phosphatase in the blood (the activity of these enzymes normalizes soon after the start of taking glucocorticosteroids). The degree of increase in ESR and CRP usually corresponds to the severity of pain and movement disorders. If signs of giant cell arteritis are detected, it may be necessary to consult an ophthalmologist, angiologist, to perform an ultrasound scan of the main arteries of the neck, extremities and aorta, as well as to perform a biopsy of the temporal artery.

Differential Diagnosis

Differential diagnosis is carried out mainly with paraproteinemic hemoblastoses and (myeloma, etc.), psoriatic and rheumatoid arthritis, polymyositis, systemic vasculitis, soft tissue diseases of the musculoskeletal system, osteomalacia, hyperparathyroidism, acute infections accompanied by myalgia.