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POLYMYALGIA RHEUMATICA and TEMPORAL ARTERITIS

If you develop severe muscle pain and weakness, primarily in your shoulder or pelvic muscles, check with your doctor. You may have a highly treatable condition called polymyalgia rheumatica. Polymyalgia rheumatica usually affects people over 60 years of age who were previously healthy. The pain in their shoulder or pelvic muscles is so great that they often can't sleep nights and that they are afraid to move their muscles days. Doctors order a blood test called a sed rate, and if it is very high, they suspect polymyalgia rheumatica.

If a person suffers severe headaches, doctors should suspect migraine or a much more serious condition, called TEMPORAL ARTERITIS, that can cause permanent blindness. They often biopsy arteries near the skull to diagnose that condition. The only effective treatment is cortisone-type drugs like prednisone, which usually clear the horribly crippling muscle and joint pain within a few days. Then doctors try to reduce the dose of prednisone to the smallest doses that suppress muscle pain. Most people with this condition must continue to take prednisone for a year or two and then the condition often goes away as mysteriously as it came.

Many doctors feel that this condition is caused by some kind of infection, even though they have never been able to associate any specific germ with this condition previously. Recent research shows that polymyalgia rheumatica may be caused by infection with parainfluenza virus (1). There is no research on this, but treatment then could be immune gamma globulin injections. Some doctors treat polymyalgia with long-term antibiotics, such as doxycycline, in addition to the prednisone.

The only way to prove that you have temporal arteritis is to cut out a piece of your artery and see the irritation in the inner lining of the blood vessels called arteritis. To prevent sudden blindness, your doctor prescribes prednisone, a cortisone-type drug that reduces swelling. Several recent papers show that damage to the inner linings of arteries in your temples and brain can be caused by infection ( 3,4) with chlamydia, the same bacteria that causes heart attacks (1), parvovirus B19 (2) and parainfluenza type 1 (5). At this time, it may be good medicine for your doctor to prescribe antibiotics such as Zithromax (250 mg a day) or Biaxin (500 mg twice day) for a week along with the usually prednisone.

1) AD Wagner, HC Gerard, T Fresemann, WA Schmidt, E GromnicaIhle, AP Hudson, H Zeidler. Detection of Chlamydia pneumoniae in giant cell vasculitis and correlation with the topographic arrangement of tissue-infiltrating dendritic cells. Arthritis and Rheumatism, 2000, Vol 43, Iss 7, pp 1543-1551.

2) H Elling, AT Olsson, P Elling. Human Parvovirus and giant cell arteritis: A selective arteritic impact? Clinical and Experimental Rheumatology, 2000,Vol 18, Iss 4, Suppl. 20, pp S12-S14.

3) E Nordborg. Epidemiology of biopsy-positive giant cell arteritis: An overview. Clinical and Experimental Rheumatology, 2000, Vol 18, Iss 4, Suppl. 20, pp S15-S17.

4) C Nordborg, E Nordborg, V Petursdottir. The pathogenesis of giant cell arteritis: Morphological aspects. Clinical and Experimental Rheumatology, 2000, Vol 18, Iss 4, Suppl. 20, pp S18-S21.

5) P Duhaut, S Bosshard, C Dumontet. Giant cell arteritis and polymyalgia rheumatica: Role of viral infections. Clinical and Experimental Rheumatology, 2000, Vol 18, Iss 4, Suppl. 20, pp S22-S23. Human parainfluenza type 1 virus.

Checked 8/9/05

May 30th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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