Polymyalgia often mistaken as arthritis

DEAR DR. DONOHUE: Both my shoulders started to hurt about a month ago. I thought it was arthritis. They were most painful and stiff early in the morning. The pain got so bad that I could hardly put on a shirt. I knew I had to get to the doctor, and I finally did. He took some tests and ordered an X-ray. It turns out I have something called polymyalgia rheumatica. The doctor wants me to take prednisone. I refused because I know what it can do to you. Is there any other medicine I can take? -- R.K.

ANSWER: Polymyalgia rheumatica is something that happens only to people older than 50, and usually much older than 50. As many older people have it as do those who have rheumatoid arthritis. It's not at all a rare thing. Its cause isn't known.

The symptoms are much what you describe: pain and stiffness of the shoulders, hips, back and neck. All those places are not necessarily affected. The hands and feet might be slightly swollen. Symptoms are worse in the early morning, and people find it difficult to dress, comb their hair or fasten a bra.

Two lab tests help establish the diagnosis. One is the sedimentation, or sed, rate. It's a simple test in which the patient's blood is put in a calibrated tube. At the end of an hour, the distance the red blood cells have dropped from the top of the tube is measured. A high sed rate is standard for this illness. C-reactive protein, another detector of body inflammation, also is strongly positive.

If your symptoms are mild, then aspirin or other NSAIDs - - nonsteroidal anti-inflammatory drugs -- could relieve them. However, it would be wise to reconsider your position on prednisone, one of the cortisone drugs. When given in high doses for long periods, it has major side effects but polymyalgia doses are relatively small. The illness responds quickly to prednisone. If all goes well, the dose can be gradually reduced after two to four weeks even though treatment might last a year or more.

Another reason to consider prednisone is that polymyalgia is often accompanied by another inflammatory illness, temporal arteritis. If this illness isn't treated quickly, it can cause blindness. Prednisone is its treatment.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475,Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com. 2006 orth America Syndicate Inc. All Rights Reserved