The name dates back to a time when hardly anything was known about these diseases. The name(poly = a lot, myalgia = muscle pain, rheumatica = flowing) contributes to considerable confusion. It is true that the patient feels pain in the muscles.
However, the muscle tissue is not pathologically altered. Instead, it is an inflammation of anartery that runs through the muscle.
The inflammation of an artery is called arteritis. One speaks of giant cell arteritis if
The term polymyalgia rheumatica is commonly used when
There is disagreement among doctors as to whether these are two different diseases or whether giant cell arteritis is the particularly advanced form of polymyalgia rheumatica.
The treatment is basically the same, but the dosage of medication is higher in giant cell arteritis.
Other names for this disease are
Arteries (red) run through the muscle tissue © Anatomy Insider | AdobeStock
During the inflammatory process, inflammatory cells (white blood cells - leukocytes) migrate into the arterial wall. This leads to the formation of giant cells. The artery wall becomes thicker, firmer and constricts the artery more and more.
This process develops segmentally. This means that some sections (segments) are severely affected by the narrowing, while others are spared. A sufficiently long piece must therefore be removed when tissue is removed.
The constriction of the blood vessels means that the affected organs are no longer adequately supplied with blood. In the case of total occlusion, these organs even die. This process can affect any organ or body region.
In some areas, this can cause medical emergencies:
Polymyalgia rheumatica is therefore a painful and in some cases life-threatening disease. Only timely detection and immediate treatment can avert the impending damage and lead to a rapid improvement in the considerable pain.
A cause or trigger has not yet been found. A certain hereditary predisposition is suspected. However, it is not a hereditary disease in the true sense of the word.
Within a few days to 2 weeks, severe pain occurs, mainly in the area of the neck
occur. This pain can also occur in the
can also occur. Initially, the pain is usually present on both sides. It is constant pain at rest, which at best fluctuates slightly with the time of day. It therefore also occurs without strain or movement of the affected body parts.
After weeks, the pain can take on an undulating character and shift. The patient also complains of
A physical examination by a doctor often reveals no particular abnormalities. However, it should be carried out in any case, as other illnesses can show similar symptoms.
In some cases, swollen joints are found.
Symptoms such as
can be harbingers of the serious complications described above. The disease is often accompanied by severe depression. However, this can usually be cured with the right therapy.
Headaches and dizziness can occur when the cerebral artery is affected © goodluz | AdobeStock
It mainly affects older people. The average age of onset is 70 years. The number of new cases increases with age. It is 7 times higher in 90-year-olds than in 60-year-olds.
As it is a disease of old age, the pain is often not associated with inflammation. At this age, the joints and spine are already showing signs of wear and tear, so that pain in these areas is not noticeable.
Important clues for patients are therefore
The erythrocyte sedimentation rate (ESR) is moderately to severely elevated in polymyalgia rheumatica. The C-reactive protein (CRP) also increases. These values can be used to assess the course of the disease. However, BKS and CRP are non-specific inflammation markers, i.e. they increase with almost any type of inflammation, e.g. also with banal flu or other inflammations.
In addition, there may be an increase in blood platelets (thrombocytes) and a shift in blood proteins.
X-rays usually reveal age-appropriate findings. These include wear and tear of the spine or joints, but no signs of inflammation.
The diagnosis of polymyalgia rheumatica is confirmed by
laboratory tests.
Giant cell arteritis, on the other hand, is only diagnosed by removing a blood vessel and microscopic examination.
However, this only makes sense if a suitable body site can be found. This must be carefully selected. The sampling, just like the microscopic examination, is a matter for an experienced specialist.
If thickened arteries can be felt in the temple area, the vessels should be removed. If giant cell arteritis is present, the necessary medication must be given in higher doses.
It is not possible without cortisone preparations! A prompt response to cortisone preparations is typical. In medical terminology, cortisone preparations are also known as glucocorticoids or corticoids for short. If the dosage is sufficient, relief from symptoms is achieved within a few hours to days.
The laboratory signs of inflammation (BKS and CRP) also normalize. This happens within a few days in the case of CRP, but may take a little longer in the case of BKS.
The dose must be increased further if
The patient must now expect treatment to last for years. It is therefore important for them to talk to their doctor and familiarize themselves with the consequences of corticosteroid therapy. In particular, there is a risk of osteoporosis. The initially high dose may only be reduced slowly.
In osteoporosis, bone density decreases and bone fractures can occur more quickly © crevis | AdobeStock
If the dose is reduced too quickly, the pain will return and/or the BKS/CRP will rise again. The dose must then be increased until the patient is symptom-free and the laboratory values are within the normal range.
The doctor should be consulted before each dose reduction and the BKS should also be determined. If the eyes are affected, the emergency brake should be pulled, as otherwise there is a risk of irreversible blindness. In this case, the initial dose must be set particularly high.
If there is a high need for corticosteroids or if a low dose cannot be achieved within 6 to 9 months, additional therapy with methotrexate or azathioprine may be considered. These therapies are the responsibility of an experienced specialist.
Classic rheumatism and painkillers can at best alleviate the pain. They mask the progressive inflammation of the blood vessels and are not an appropriate therapy.
The disease usually lasts 3 to 4 years. However, courses of 10 years and longer are also known.
It is not cured by the necessary medication, but only suppressed. Even with successful therapy, it is not certain whether the disease has really disappeared.
If the therapy is discontinued too quickly, it can lead to a relapse or even blindness. An attempt to stop, i.e. the slow discontinuation of all medication, should be made after 2 years at the earliest.
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