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Polymyalgia Rheumatica

Polymyalgia rheumatica, an inflammatory disease that usually affects women, causes muscular pain and stiffness in the shoulders, neck, and hips (Salvarani 2004; Hellmich 2005).

In people with polymyalgia rheumatica, synovial membranes and bursae, which line and lubricate the joints, become inflamed, causing pain and discomfort (Salvarani 1997; Meliconi 1996; McGonagle 2001; Pavlica 2000). Unlike the case with some other inflammatory diseases (eg, rheumatoid arthritis), no permanent damage to either the joints or muscles is associated with polymyalgia rheumatica. The disease typically resolves in a few years.

Nevertheless, during the disease course, polymyalgia is a painful condition that significantly affects quality of life. Standard conventional treatment for polymyalgia rheumatica involves non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids to reduce inflammation and pain. Unfortunately, this arsenal of treatment options is far from ideal. NSAIDs are rarely effective, so corticosteroids are generally used as first-line therapy. However, corticosteriod drugs are associated with significant side effects, including osteoporosis. The longer the treatment lasts, and the higher the dose(s) used, the more likely a patient will suffer serious side effects. One major goal of conventional therapy is to use the smallest dose of corticosteroids possible and taper off as soon as symptoms resolve.

Nutritional therapy offers an important adjunct approach to polymyalgia rheumatica. Even though there is a lack of serious nutritional research into polymyalgia rheumatica, the inflammatory cascade that underlies the disease is well understood. By using proven anti-inflammatory supplements, it may be possible to reduce dosages of strong prescription drugs and reduce symptoms. In addition, inflammation associated with the disease causes impairment of the adrenal hormone system, resulting in a deficiency in vital hormones that need to be replaced.

It is important to note that a significant number of people with polymyalgia rheumatica also suffer from a condition known as giant cell arteritis (Hellmich 2005; Gonzalez-Gay 2004). Giant cell arteritis involves inflammation of the temporal artery (a major craniofacial artery), and other arteries can also be inflamed (Weyand 2003). Aneurysms can form in these weakened vessels (Honing 2005). Because the temporal artery supplies blood to the eye, blindness is a possible consequence of giant cell arteritis (Weyand  2004). Up to 75% of patients with giant cell arteritis may have aortitis (inflammation of the aorta), although the condition is not always diagnosed (Honing 2005). Recently, noninvasive imaging techniques, especially magnetic resonance imaging, have been used to determine the true degree of aortitis in patients with giant cell arteritis (Narvaez 2005). Because of its significant consequences, patients with polymyalgia rheumatica should be carefully monitored for signs or symptoms of giant cell arteritis.