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Treating Polymyalgia Rheumatica?

What should my wife take for polymyalgia rheumatica?

Answer (Published 4/20/2004)

(Updated 1/24/2005)

Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and morning stiffness (sometimes both quite severe) in the upper arms and legs, neck, shoulder and hip areas. It occurs primarily in older people (the average age at diagnosis is 70), rarely is diagnosed before age 50, and affects women twice as often as men. Although no one knows what causes it, immune system abnormalities and genetic factors are suspected.

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Polymyalgia rheumatica seems to be related to another condition, giant cell arteritis (also called temporal arteritis and cranial arteritis), which causes inflammation in the arteries in the head (usually those in the temples). The inflammation causes swelling which narrows or stretches the arteries and may pose a threat to vision. About 15 percent of people in the United States who have polymyalgia rheumatica also have giant cell arteritis, and about half the people with giant cell arteritis also have polymyalgia rheumatica. Because of the threat to sight, those with giant cell arteritis in addition to polymyalgia rheumatica must take the steroid drug prednisone until symptoms disappear and tests show that there is no longer a risk of blindness. Signs of this disorder can include headache, pain in the temple, blurred or double vision, and flu-like symptoms.

Polymyalgia rheumatica may begin abruptly but usually develops in a gradual manner over a couple of weeks. Mild or early cases are marked by morning symptoms (lasting one to two hours after waking, then returning after periods of inactivity) as well as fatigue, a sense of weakness, weight loss and low-grade fever, all of which can accompany the pain and stiffness.

The disease often goes away without treatment in a year or more, but prednisone can bring the symptoms under control within a day or two. The drug really works well for this condition although you always want to take the lowest possible dose and discontinue treatment as soon as possible. Typically, the initial dose is increased until symptoms disappear, and then gradually decreased to the lowest amount needed to relieve symptoms. Treatment usually continues for six months to two years but may be restarted if symptoms recur.

At first, your wife will need prednisone for the relief it offers. She also might try aerobic exercise, which a friend affected with this condition has told me makes a big difference. I also recommend whole licorice for treatment of inflammatory disorders. You can find whole licorice as a root or extract. Look for products with six to 10 percent glycyrrhizin and follow the dosage direction on the package. Since whole licorice can worsen high blood pressure, check with your doctor before taking it if your pressure is high. Licorice root capsules can be used in the amount of 5-6 g per day. Concentrated extracts can be used in the amount of 250-500 mg three times per day. This approach may enable your wife to lower her prednisone dose. In addition, she should try to maintain an anti-inflammatory diet. Chinese medicine and mind/body techniques such as hypnotherapy and guided imagery can also help.

Andrew Weil, M.D.

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