Polimialgia Reumatica Dangers Of Corticosteroids
Polimialgia reumatica and giant cell arteritis (GCA) are both overlapping inflammatory rheumatic diseases whose causes have not been identified. They share some clinical features and happen in adults over the age of 50 years old. In the United States of America and the United Kingdom it is estimated the annual incidence of GCA is 188 to 220 cases per one million people. For polimialgia reumatica the annual incidence varies from 120-1120 per million depending on the country of choice.
Giant cell arteritis is easier to diagnose than polimialgia reumatica. The typical presenting symptoms are a new, not normal headache that feels like head pain that is associated with an increased erythrocyte sedimentation rate or a high C-reactive protein level. The most feared side effect of gca is permanent visual loss. This occurs in approximately 15% of cases and is the reason why GCA is treated as a rheumatologic emergency. Other possible but less common signs and symptoms include jaw or tongue numbness which happens as a result of decreased blood to the head and jaw due to inflammation narrowing the arteries. Upon further testing about half of sufferers will have vascular inflammation affecting several main arteries throughout the body.
Polimialgia reumatica on the other hand presents with stiffness and aching of the neck, shoulders and hips. Associated with this by one third of patients is weight loss, fever and mental disturbances like depression. There may be no known cause for the onset. The symptoms may appear almost overnight or develop over a period of a few days. Although pain and stiffness may feel like they are originating in the joints or bones, that is not the case. Polimialgia reumatica only affects the muscles or the muscle attachment to the bone called the tendon. It is usually present on both sides of the body. Often a final diagnosis may take some time as other conditions such as neurological, hormonal and endocrine are ruled out.
Both polimialgia reumatica and GCA are typically treated with corticosteroids. Although the goal is to lessen the amount of corticosteroid to a maintenance level as soon as possible. This is done to try and prevent coricosteroid toxicity and therefore the goal is to find the lowest dose possible that still alleviates symptoms. Currently there is no definitive protocol for this method and it will involve some trial and error. Usually a medium to high starting dose will be used to begin with, followed by careful monitoring of symptoms and side effects.
More than half of patients with polimialgia reumatica and about one third of GCA have a relapse of the condition and therefore need to stay on corticosteroids therapy for several years. A large number of relapses happen in the first year of treatment in conjunction with the corticosteroid dosage being reduced to less than 7.5mg per day.
As a adjunct to pharmaceutical treatment for Polimialgia reumatica there can be some benefit in changing lifestyle, adjusting dietary habits and adding nutritional supplements. Stress or anxiety can activate some pro-inflammatory conditions within the body, so learning to increase relaxation in your life can be beneficial. Decreased take away or processed foods and supplying your body with more key vitamins and minerals can only serve to help your body during the healing process. There are a few supplements that have been shown to help with inflammation and decreasing that in the body.
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