“Wow, I guess I’m just getting old. Everything hurts and I’m tired even doing little things.” Mrs. Jennings, in her early sixties, was normally one of my more energetic patients. On further questioning it turned out it really wasn’t “everything” that hurt, but particularly the muscles of her thighs and shoulders, not so much her joints. Her tiredness was notable particularly when she would exert herself, like walking up her back hill. She would get back into her house from coming up the hill and feel totally out of breath, achy and exhausted. All this was a rather striking change from just a couple weeks ago when none of this gave her much trouble at all.
Was she right that age had finally caught up with her? Or maybe she had some hidden cancer, or late-onset rheumatologic disease, or any number of other problems. Most of the tests came back pretty normal, but an old, simple blood test, the sedimentation rate, was very high. It’s a non-specific test, but together with her other symptoms and the normalcy of most of the rest of her tests, it pointed to a diagnosis we see only occasionally: polymyalgia rheumatica (PMR). The clincher would be how she responded to a course of oral steroids. They tend to work like magic with PMR and that helps confirm the diagnosis. Sure enough, a week or so after starting the steroids, we had the younger, energetic version of Mrs. Jennings back. She was again motoring up her back hill like it was nothing.
As with Mrs. Jennings’ episode, PMR involves the rapid onset of soreness in the large muscles of the thigh and shoulders with a sense of weakness and fatigue. Sufferers are almost always over age 50 and more than twice as many women as men get it. The cause is not known and is thought to possibly be autoimmune. As noted, steroids work wonders for PMR and can then be slowly tapered over many months. The entire course of PMR averages about three years. It’s one of those diagnoses you don’t want to miss since it’s so debilitating to have, but so very treatable.
Importantly, about 15% of people with PMR also have a condition called giant cell arteritis (GCA), which has also been called temporal arteritis. GCA involves inflammation of arteries, most commonly the temporal arteries on either side of the forehead. GCA causes a substantial temporal headache, and if untreated (with higher dose steroids), can even cause sudden blindness. Mrs. Jennings actually had some temporal pain that came and went. In the end we had her get a temporal artery biopsy but happily it was normal.
It is always very satisfying, to doctor and patient alike, to see the debilitating fatigue, weakness and achiness of PMT quickly melt away with treatment. And unlike almost 50% of individuals with PMR, Mrs. Jennings did not experience a relapse. Several years later, she’s still going strong, motoring up her back hill like its nothing.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835