Polymyalgia Rheumatica and Good Nutrition

Do you know what PMR or polymyalgia rheumatica is? It is an inflammatory disorder which can cause muscle aches and stiffness mostly affecting the shoulders, neck, upper arms, hips and thighs. These symptoms can develop gradually in some people but can also appear overnight in others. The causes are not exactly known but it may be a faulty immune system, genetic or environmental factors of simply a facet of aging. It may go away on its own within a year or two, however, there self-care techniques as well as medications that can be used to treat PMR instead.The symptoms of PMR include:- Mild to severe stiffness or aching in the muscles of the thighs, shoulders, hips, upper arms and the neck.- Fatigue- Unexpected or unintentional weight loss- Weakness or malaise- A slight fever (may not be present in all cases)- AnemiaThe pain that you feel may start in only one side of the body but may affect both sides as the disease progresses. It is usually worse after lying down for long periods, and the pain may be severe enough to wake you at night. Between 10 to 20 percent of those with polymyalgia rheumatica have an additional, related condition called giant cell arterititis. This condition causes the arteries in the temples, the neck and sometimes the arm to become swollen and/or inflamed.Polymygalgia rheumatica is an arthritic syndrome that causes mild inflammation in the joints and surrounding tissues and leads to the pain and stiffness. Because the inflammation tends to be more diffuse, the pain is typically not as severe as in other types of arthritis. In total, there are over 100 different types of arthritis ranging in degree of severity and the potential disability they may cause. The Arthritis Foundation estimates that about 20 million Americans suffer from some form of arthritis that is severe enough to need medical attention and affects women more often than men. (Source: MacLean 1993) In addition, the disease typically only strikes those who are older, with the average age at its start being 70. There are a number of viruses that have been linked to PMR, including adenovirus, human paraovirus B19 and human parainfluenza virus.The family of Monica S. is worried. She went to bed on Sunday night feeling rather spry for her 76 years and without any aches or pains. When she woke on Monday morning, however, she found that she was barely able to move and she was in fairly troubling pain. She calls her doctor thinking that she will be told to take a few aspirin and to put a heating pad on, but her doctor schedules her in for that very afternoon. After talking to her at great length and making sure that she has not had any falls or other accidents that could have produced an injury, her doctor orders a number of tests. At the laboratory, Monica will have blood drawn for tests that include:- Sed Rate: This test, the erythrocyte sedimentation test, measures how quickly the red blood cells settle when placed in a test tube. Sed rate increases when inflammation is present anywhere in the body, which can be caused by a number of conditions and illnesses.- Rheumatoid Factor: RF is an antibody (a protein which is made by the immune system) present in the blood in those who do have rheumatoid arthritis but absent in those with polymyalgia rheumatica.- Total Blood Count: the doctor will check and compare the number of red blood cells and platelets, also called thrombocytes, in the blood. People with PMR tend to have a high number of platelets, a condition called thrombocytosis, but also tend to have lower than average red blood cell counts, leading to anemia.- A blood test that checks for c-reactive protein in the blood is also performed. This substance is created by the liver in reaction to injury or infection in the body. High blood levels of CRP indicate inflammation.After confirming his suspicions, Monica’s doctor asks for additional testing to make sure that she does not have giant cell artertitis as well – she does not have any of the symptoms of this related condition at this time, which can include headaches, pain when chewing and some vision changes, so he does not want to do a biopsy at this point. However, he might if any of these become evident.In addition to prescribing a number of medications for Monica, the doctor also has a number of suggestions for her to follow at home so that she can have less and less pain. She has never been a big fan of taking medications, so the sooner she can stop taking them, the better she will feel. Of these suggestions, exercise and healthy diet are two of the easiest for her to follow. She has been devoted to both yoga and Pilates since she was younger and was afraid that the doctor was going to tell her she had to give them up. He is thrilled that she is so willing to move despite the stiffness and pain that she feels. He also suggests that she join the water aerobics class that is specifically designed for those with arthritis. The water reduces the amount of stress on her joints and helps her to move with a little more comfort.Monica’s diet has always been a fairly healthy one, but she does agree that she might need to increase her protein intake slightly. She also is trying to include more fatty fish in her diet for the benefits not only to her heart but to her joint health as well. This will help with the protein intake as well as using a supplement. With this small liquid protein, she gets protein in a small size that only takes seconds to consume. She does not have to worry about mixing anything, although she can mix it with other foods or beverages if she feels that she needs to. There are a number of flavors that she can try as well as a number of additional sizes for convenience besides the single-serving 2.9 ounce size.The additional protein is also beneficial to her immune system (as antibodies are proteins), and she also includes a number of plant-based proteins to her diet as well.Because a number of the medications that are used to treat polymyalgia rheumatica can be problematic for bone health, she is making sure to get enough calcium and vitamin D from her diet, but because they are so important, takes supplements as well so that she can prevent osteoporosis. She will also watch for other conditions related to the meds that she is taking, including cataracts and high blood pressure. She may also gain weight on some of these meds and may have problems with elevated blood sugar. Because of the seriousness of the side effects, Monica will continue to be monitored by her doctor and will stop taking these meds as soon as possible.ReferencesHelen MacLean, Editor. Every Woman’s Health: The Complete Guide to Body and Mind by Fifteen Women Doctors Fifth Edition. Doubleday Book and Music Clubs Inc. Garden City, New York 1993Mayo Clinic Staff Polymyalgia Rheumatica mayoclinic.com

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