To Your Good Health

DEAR DR. ROACH: My cousin, a woman in her mid-50s, was recently diagnosed with polymyalgia rheumatica. She was diagnosed early and has been on the standard prednisone treatment for seven days. She's been athletic most of her adult life and became concerned when the pain she was suffering was different from normal athletic pains.

Her mom (my aunt) also had PMR, but not until her late 70s.

I'd like to know more about PMR, its treatment and the likelihood of it being hereditary.

Would exercises, supplements or an anti-inflammatory diet help? — N.P.

ANSWER: Polymyalgia rheumatica is a common but underdiagnosed inflammatory rheumatic condition found almost exclusively in older adults.

It most often causes pain in the muscles of the arms, shoulders, neck and torso, and is typically much worse in the morning. It is more frequent in women.

Both sides of the body are equally affected.

The diagnosis is made based on symptoms, but a blood test helps support the diagnosis.

Virtually all people with PMR respond rapidly and dramatically to low-dose (10-20 mg) of prednisone. Only half of people are able to stop the prednisone within a year or two.

There is a familial association with PMR; however, it's a common disease. One woman in 40 will get it in her lifetime (for men, it's less common, 1 in 70). A family history is certainly not necessary to get the condition.

Supplements and an anti-inflammatory diet may relieve symptoms in some people.

Whether or not this is a placebo effect is difficult to say.

The prednisone is a much more powerful anti-inflammatory than any diet or over-the-counter supplement.

Exercise has benefit in preventing deconditioning but not managing the actual condition.

DR. ROACH WRITES: A recent column on chest wall syndrome motivated many readers, including some of my physician readers, to ask about costochondritis.

The costochondral junction is where the rib (“costa” in Latin) meets the cartilage (“khondros” in Greek), and that area can become inflamed and painful. Acute costochondritis is most commonly caused by a virus, especially Coxsackie B viruses.

The pain can be exquisite, but it is usually short-lived.

In my recent column, the pain had been going on five months, so the diagnosis is likely chest wall syndrome, which is more a syndrome than a specific diagnosis.

Costochondritis is a more specific diagnosis, unlikely in this case due to the longer time course.