Ask the doctors: No new treatments for polymyalgia rheumatica

Dear Doctor: I am a 77-year-old man who used to exercise regularly. I was diagnosed with polymyalgia rheumatica a couple of years ago. Sometimes I feel like it is going to disappear, and other times it seems to worsen. Are there any new remedies?

Dear Reader: Polymyalgia rheumatica, also known as PMR, is an inflammatory condition that affects joints and muscles, most often in the neck, shoulders, hips, thighs and lower back. Some patients report a gradual onset of the condition. For others, it appears quickly, seemingly overnight.

Symptoms of PMR include significant muscle pain, accompanied by ongoing stiffness. These both tend to increase after periods of rest or inactivity, and can be severe enough to interrupt sleep. Pain and stiffness are most pronounced in the morning. The stiffness caused by PMR often improves within a few hours after waking – being active helps, too – but the pain remains. Additional effects may include flulike symptoms such as fever, malaise and exhaustion. PMR is rarely seen in anyone younger than 50, and is most often diagnosed at age 60 and older. It’s also more common in women than in men.

Although the cause of PMR isn’t known, it is strongly suspected to be an autoimmune disease. That means the body’s immune system is attacking its own tissues, giving rise to the systemic inflammation that’s causing the pain and stiffness. Research into PMR has also suggested a genetic component. The condition appears to be more common among people of North European descent than it is among those from the Mediterranean.

As you probably know, having lived with the condition for a few years, the primary treatment for PMR is corticosteroids, such as prednisone. Patients report a swift reduction in pain and stiffness often two or three days after starting steroid therapy. Due to potential complications associated with steroids, including an increased risk of infection, diabetes, high blood pressure and osteoporosis, the goal is to find the lowest dose possible to manage pain. Once symptoms are under control and the results of certain blood tests show improvement, steroid therapy is gradually tapered to the lowest effective dose.

There are currently no new treatments for the condition. A class of medications known as disease-modifying antirheumatic drugs, or DMARDs, are sometimes used to reduce reliance on steroids. And there is increasing interest in the use of monoclonal antibodies, which are lab-created molecules that act on, or with, the immune system.

Some people living with PMR report improvement when they switch to a low-inflammation diet, such as the Mediterranean or DASH diets. Foods that are associated with anti-inflammatory properties include leafy greens, fruit, nuts, whole grains, fatty fish and green tea.

If you haven’t already done so, we urge you to let your doctor know whenever your symptoms get worse. A challenge of aiming for a minimal dose of any medication is that the dosage might drop below what is necessary. Ask your doctor if a slight adjustment in your medication is needed.