Both the inflammatory rheumatic diseases polimialgia reumatica and giant cell arteritis (GCA) are often overlapping conditions with undiscovered causative factors. There are some clinical indicators that are common to both conditions and they typically occur in adults over the age of fifty years. As far as the incidence of both disorders in America and England it is estimated that GCA occurs approximately 200 cases per 1 million people. For polimialgia reumatica depending on the country of choice the annual incidence can be anywhere from 120 – 1120 per million.
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.
A standard approach of corticosteroids is used for both the treatment of GCA and polimialgia reumatica. The best practice is to find the lowest dose possible that can still provide symptomatic benefit, this is termed a maintenance dose. This is desirable to decrease toxicity from the drug. During the current day there is no set way for determining this dose for each individual other than trial and error. Typically people will begin on medium or high doses and this is monitored and then lowered gradually.
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.
In conjunction with a medical approach for polimialgia reumatica some sufferers have benefit from lifestyle and dietary changes and nutritional supplements. Trying to reduce the amount of stress in your life and promoting a calm and relaxing mind can benefit some individuals. Improving your diet and decreasing the amount of processed foods that you eat and increasing the amount of fresh fruit and vegetables can only be beneficial to helping your body cope with both these disorders. Also the addition of natural supplements that are aimed at reducing inflammation can help.