If you have difficulty raising your shoulders, going up and down stairs, and cannot find the cause of the disease, be alert to this disease!

Author: Deng Xuerong, Chief Physician, Peking University First Hospital

Reviewer: Mu Rong, Chief Physician, Peking University Third Hospital

Vice Chairman of the Young and Middle-aged Committee of the Chinese Medical Association Rheumatology Branch

For those over 50 years old, the pain may occur within a short period of time or suddenly. It is difficult to lift the shoulders, comb the hair, and get dressed. There is obvious pain in the hip area, which is the root of the thigh. It is also difficult to go up and down the stairs.

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These symptoms affect daily life, and many tests have not found the cause. If they are accompanied by low fever, you should think of this disease - polymyalgia rheumatica.

1. What kind of disease is polymyalgia rheumatica?

Polymyalgia rheumatica is an autoinflammatory disease that is more common in the elderly over 50 years old. This disease mainly causes muscle pain, stiffness and movement disorders in the shoulders and hips. Some patients may also have low-grade fever, fatigue, loss of appetite, etc.

Polymyalgia rheumatica is a common disease among the elderly, and its specific cause is not yet very clear.

The subjective symptoms of patients with polymyalgia rheumatica are quite obvious. The persistent pain makes them unable to take care of themselves, which greatly affects their quality of life. If not treated in time, it may lead to movement disorders of the affected shoulder and hip joints and muscle atrophy. The activities of the elderly are affected, which may lead to other complications later.

2. What tests are needed to diagnose polymyalgia rheumatica?

If you have the above symptoms and come to the rheumatology department, you will usually have some blood tests, such as blood routine, erythrocyte sedimentation rate, and C-reactive protein. Blood routine may show a slight increase in white blood cells, and the main abnormal changes are a significant increase in erythrocyte sedimentation rate and C-reactive protein, which are generally above 50mm/h.

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For patients with obvious joint pain and swelling, some imaging tests, such as joint ultrasound, will be performed to see if there is inflammation in the joint and how severe the inflammation is.

For patients with particularly obvious wasting symptoms, it is necessary to rule out whether it is caused by a tumor. Some cases of polymyalgia rheumatica are accompanied by tumors and may be a precursor to the tumor. The most important thing is to rule out other diseases with similar symptoms.

Once the diagnosis of polymyalgia rheumatica is confirmed, treatment should be started.

3. How to treat polymyalgia rheumatica?

Polymyalgia rheumatica is generally treated with glucocorticoids, such as oral glucocorticoids such as prednisone acetate and methylprednisolone.

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Low-dose glucocorticoids have a particularly significant therapeutic effect on polymyalgia rheumatica. After taking the medicine, patients will generally see significant improvement in symptoms as early as the same day or within two or three days.

In addition to glucocorticoids, some nonsteroidal analgesics and anti-inflammatory drugs are sometimes used. Nonsteroidal analgesics and anti-inflammatory drugs are generally used on demand, when pain occurs, and can be stopped when the pain is relieved. There is no need to take them for a long time.

When glucocorticoid treatment is ineffective or it is very difficult to reduce the dosage, such as repeated relapses, immunosuppressants such as methotrexate, leflunomide, or traditional medicines such as tripterygium wilfordii will be used in combination.

Polymyalgia rheumatica is a chronic disease and the medication cycle is generally long, possibly more than a year.

Glucocorticoids have a very good therapeutic effect on this disease, but long-term use will also bring some side effects, such as weight gain; increased risk of osteoporosis; increased blood pressure and blood sugar; and increased risk of infection.

Therefore, we should pay attention to the medication techniques of glucocorticoids, such as medication time, dosage, etc. While using glucocorticoids, we should take some preventive measures, such as calcium supplements, vitamin D, etc., to prevent the occurrence of osteoporosis.

Although glucocorticoids are very effective in treating polymyalgia rheumatica, some patients stop taking the medication on their own or reduce the dosage too early, which can lead to a relapse of the disease. Once a relapse occurs, glucocorticoid treatment may need to be restarted. Therefore, you must follow the doctor's instructions on medication, dosage reduction, and discontinuation.