Is permanent remission from rheumatica possible?

DEAR DR. ROACH: I am a 69-year-old woman who has been recently diagnosed with polymyalgia rheumatica after three months of severe pain and no diagnosis. I am now on prednisone with some pain relief. It is worse in the evening and I take the prednisone before bed. There is a great deal of pain and some weakness in all my joints, but particularly in my shoulders and arms. There also is some random aching and pain in various parts of my body all day. What is this condition and its prognosis? Will I ever have a permanent remission? — G.C.

ANSWER: “Polymyalgia” means “pain in many muscles”; “rheumatica” dates from the theory of humours, from a Greek word meaning “flow,” thought to be the reason people developed joint pains. The disease polymyalgia rheumatica occurs in about one person per 1,000 per year, almost exclusively in people older than 50, and is most common in people in their 70s.

You have some classic features and some that are not typical. The location of the worst pain being in the upper arms, shoulder and neck is classic, and it usually begins suddenly. However, nearly everybody I have seen with PMR has had symptoms that are worse in the morning, and one source I read stated that people who lack morning stiffness do not have PMR. Stiffness is worse after any period of inactivity.

The other reason I am not certain of the diagnosis is your response to prednisone. Patients with this disorder start feeling themselves getting back to normal within a few days, and are nearly 100 per cent better within a few weeks. A laboratory test, the erythrocyte sedimentation rate (“sed rate,” or ESR), is almost universally very abnormal. There are other rheumatic diseases that I trust your doctors are considering.

If this is PMR, the prognosis is good and the disease will run its course over time. Most people are on prednisone for a year or two. There are newer treatments being looked at to spare the bad effects of even moderate-dose steroids for that time.

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