Katherine Poehlmann, PhD, provides a comprehensive overview of polymyalgia rheumatica (PMR), a common inflammatory muscle disease, largely affecting the elderly. She describes the prevalence of PMR and its clinical presentation, also offering insight into possible infectious causes and the potential for misdiagnosis. Detailing the conventional treatment of PMR, Katherine additionally outlines alternative and supportive approaches to successfully treat this rheumatic disease.
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Polymyalgia rheumatica (PMR), the most common inflammatory disease in the elderly
Katherine Poehlmann, PhD
What is PMR?
According to the Vasculitis Foundation, PMR is an inflammatory autoimmune disease that attacks the blood vessels, the arteries and some major branches of the aorta, and the lining of joints. PMR is the second-most common rheumatic disease after rheumatoid arthritis (RA), primarily afflicting those over 50. Prevalence in the USA is about 1 in 142, or 1.9 million people, but this figure represents only reported diagnoses.
Symptoms of PMR
Polymyalgia rheumatica is a Greek medical term that literally means, “pain in many muscles and joints.” A layman’s translation might be, “Everything hurts.” The most common areas of pain and stiffness are in the neck, shoulders, upper arms, and hips, but may occur anywhere in the body. Pain can be sudden and acute or develop gradually. Those with PMR may also have giant cell arteritis (GCA, temporal arteritis), an inflammation of blood vessels in the face, which can cause blindness if not treated promptly.
Cause(s) of PMR
The cause of PMR is unknown in conventional medicine, but a number of infectious agents have been suggested. A study in Denmark linked peaks of PMR and epidemics of parvovirus B19, Mycoplasma pneumoniae, and Chlamydia pneumoniae infections. In 2015, Japanese researchers reported a case study of PMR developing soon after influenza B vaccination. This led them to speculate about the link between PMR and specific human leukocyte antigens (HLAs), such as HLA-DRB1 and HLA-DQB1. Whether post-vaccination PMR was caused by the influenza B virus antigen, contamination, or adjuvants in the vaccine (ASIA syndrome) is unclear.
PMR strikes women more often than men and hormones may play a role. Low levels of DHEA have been associated with a wide variety of disorders, including inflammatory autoimmune diseases such as RA, lupus, ankylosing spondylitis, and polymyalgia rheumatica.
One theory holds that PMR is triggered by an adenovirus respiratory infection. Another is that PMR may actually be a Lyme disease (LD) Borrelia burgdorferi infection. A Western Blot test may help to detect specific antibody bands that can provide enough evidence of infection to help direct appropriate treatment. Mycoplasma strains are known to be tickborne co-infections that can sometimes accompany Lyme disease. A Lyme-literate doctor (LLMD) can best advise on chronic infections of all kinds. LLMDs generally treat Lyme disease with several antimicrobials at once, aiming to eliminate its pleomorphisms. This approach may also help treat mycoplasma infection(s) but is usually more aggressive than Dr. Brown’s low dose, pulsed antibiotic protocol.
Diagnosis of PMR
PMR is often misdiagnosed because symptoms may appear similar to other conditions (like aging, perimenopause, excessive exercise) or diseases (such as influenza, osteoarthritis, rheumatoid arthritis, and fibromyalgia). No single test can definitively diagnose PMR, but specific tests can rule out other possible diagnoses. An elevated erythrocyte sedimentation rate (“sed rate”) test is helpful to confirm PMR, but it only indicates that tissue is inflamed, a characteristic of many forms of arthritis and/or other rheumatic diseases. A test for rheumatoid factor (RF) is useful because people with RA are likely to have RF in their blood, but most people with PMR do not.
Images of body structures such as CT or MRI scans are useful to determine the location of inflamed areas. Less expensive infrared photographs by a chiropractor may be equivalent.
The best approach is to seek a thorough exam considering the patient’s full medical history, including a lifestyle and nutrition profile. This kind of in-depth exam may reveal specific vitamin or mineral deficiencies. Essential vitamins A, B, and C are especially important to control inflammation. Magnesium deficiency or low calcium can cause of muscle pain. Vitamin D deficiency, common as we age, should be tested. Muscle pain and weakness can indicate potassium deficiency.
Conventional treatment of PMR
Doctors usually prescribe corticosteroid drugs like prednisone for the inflammation associated with PMR. Most symptoms improve within 2-3 days, but some patients require years of treatment. Relapses are common because the treatment addresses symptoms, not the infectious cause(s) of the disease. Tests should be performed to rule out Lyme Disease or other persistent, chronic infections for which prednisone is not recommended.
The serious negative side-effects of long-term prednisone use should motivate patients to seek benign alternatives. One rule of thumb is that whenever a steroid drug like prednisone makes a condition better, the root cause of the condition is poor adrenal function. The Weston Price Foundation suggests dietary changes to support the adrenals. An essential part of this regimen is eliminating substances that stress the adrenals, notably sugar, caffeine (found in coffee, tea, and sodas), and nicotine.
Helpful naturopathic PMR treatments
Proper nutrition and moderate exercise (especially gentle stretching, yoga, massage, and water aerobics) can help both to manage pain and to increase muscle flexibility and range of motion. It is helpful to adopt a diet focused on specific foods that reduce inflammation. Natural anti-inflammatory supplements like fish oil, ascorbic acid (vitamin C), turmeric (curcumin), resveratrol, and ginger have been proven to be effective. Pantetheine (pantothenic acid), which is manufactured in the body from vitamin B5, is essential for the proper functioning of the adrenal glands and for the production of natural steroids, called glucocorticoids. Pantetheine also increases the levels of essential omega-3 fatty acids in the body, which also reduces inflammation. Methyl-sulphonyl-methane, or MSM, is a natural sulphur compound produced in the body that is often used to control the pain and inflammation of arthritis and can be of benefit in PMR. Bromelain, an enzyme derived from the pineapple plant, could help PMR sufferers as it reduces joint swelling and inflammation for those with RA.
Conclusion
One should get a qualified clinician’s approval before starting any diet or exercise program. Before getting a flu shot, those who have a suppressed immune system, allergies, chronic infection(s), any autoimmune disease (including PMR), or are taking statin drugs should consult an immunologist to avoid the risk of adverse reactions. Statin drugs will increase the pathology of PMR by causing mitochondrial dysfunction and making undiagnosed subclinical focal scurvy worse.
The pain and stiffness of PMR can result in a diminished quality of life, and can lead to depression. When “everything hurts” don’t ask “What do I take?” but rather, “What do I do?” Play detective to analyze your daily habits. E.g., are your muscles weak from lack of exercise? Are your cells lacking enough water to circulate your blood and provide nutrients to tissues? (Dehydration is common among those with PMR). Does your diet include a lot of salty, processed foods and not enough fresh produce?
If you suspect infection or other causes for your pain, seek credible information for diagnostics and treatment options to make fully-informed healthcare decisions. Lifestyle changes are helpful adjuncts to treatment, easy to accomplish, and can help to turn PMR around.