DEFINITION:

(from the word "polymyalgia" which means "pain in many muscles" in Greek followed by the term "rheumatica") abbreviated as PMR, is a syndrome with pain or stiffness, usually in the neck, shoulders, and hips. The pain can be very sudden, or can occur gradually over a period. It may be caused by an inflammatory condition of blood vessels such as temporal arteritis.

CAUSE: the underlying cause is unknown.

RISK: People who have the HLA-DR4 type of human leukocyte antigen

The primary function of HLA-DR is to present peptide antigens, potentially foreign in origin, to the immune system for the purpose of eliciting or suppressing T-(helper)-cell responses that eventually lead to the production of antibodies against the same peptide antigen.

OCCURRENCE:
Race: Caucasians and often 1st degree relatives Age: 50 y.o. and older Sex: two times in women

ASSESSMENT:
Characterized by severe proximal muscle discomfort with mild joint swelling Severe aching in the neck, shoulder, and pelvic muscles Stiffness most often in the in the morning and after periods of inactivity Systemic features: low grade fever, weight loss, malaise, anorexia, and depression

Giant cell arteritis - (GCA), also known as temporal arteritis or cranial arteritis is a systemic, inflammatory, vascular syndrome that predominantly affects the temporal arteries -may cause headaches, changes in vision, jaw claudication

DIAGNOSTIC EXAMS
PMR is difficult to diagnose bec. of lack of specificity of tests. NO definitive test Screening test - markedly high ESR C-reactive protein test- measures the concentration of C-reactive proteins in your blood. A high concentration of C-reactive protein indicates increased inflammation

Imaging tests - doctor may use magnetic resonance imaging (MRI) or ultrasound imaging to find inflammation of tissues within the shoulder and hip joints that can support a diagnosis of polymyalgia rheumatica. These images may also help identify or rule out other causes of your symptoms

Monitoring for giant cell arteritis- If the doctor suspects a diagnosis of giant cell arteritis, he or she will order a biopsy of the artery in one of the patients temples. This procedure, performed during local anesthesia, removes a tiny sample of the artery, which is then examined in a laboratory for signs of inflammation.

ESR - measures the distance red blood cells, or erythrocytes (uh-RITH-roh-sites), fall in a test tube in one hour. The distance indirectly measures the level of inflammation the farther the red blood cells have descended, the greater the inflammatory response of your immune system. An increased rate occurs because of certain changes to red blood cell properties in response to inflammation.

MEDICAL MANAGEMENT
Therapeutic Goals
to control painful myalgia to improve muscle stiffness to resolve constitutional features of the

disease

TREATMENT
Corticosteroids (e.g. prednisone)- treatment of choice; cause complete or near-complete symptom resolution and reduction of the erythrocyte sedimentation rate (ESR) to normal
S/E: Weight gain, Osteoporosis, High blood pressure, High cholesterol, Cataracts, Diabetes

 Corticosteroid-sparing agents- to reduce

corticosteroid-related adverse effects e.g. methotrexate- this immune-suppressing medication may help lower the dose of corticosteroid that's needed, which can help preserve bone mass. It's often given long term, for a year or more.
- Antitumor necrosis factor alpha (anti-TNF) agents - these drugs block that substance and reduce inflammation

 NSAIDs - provide supplemental pain relief Calcium and vitamin D supplements- to help prevent osteoporosis induced by corticosteroid treatment. It is the recommended daily doses for anyone taking corticosteroids for more than three months: 1,000 to 1,200 milligrams (mg) of calcium supplements

400 to 1,000 international units (IU) of vitamin D supplements

 Physical therapy - doctor may recommend physical therapy to help patient regain strength, coordination and the ability to perform everyday tasks after a long period of limited activity that polymyalgia rheumatica often causes

NURSING MANAGEMENT
Instruct patient to take the prescribed medication
Monitor the side effects of the medication (e.g. infections, DM, GI problems, and depression) Promote bone health by instructing patient to take the dietary calcium and vitamin D Encourage pt. to perform a weight bearing exercises Encourage pt. to stop smoking and reduce alcohol consumption

 NSG. MGMT for cortecosteroid: Administer the medication after a full meal or with antacid

as this may help reduce irritation of the stomach. Instruct to report immediately if the pt. have severe, persisting abdominal pain or black, tarry stools, unusual wt. gain, swelling of the extremities, or worsening of the disorder for which the drug is taken. For osteoporosis: Instruct the pt. to reduce or eliminate smoking and alcohol bec. it increases the risk of osteoporosis. Instruct to assess the risk of falls. Thoroughly examine the home and correct situations that might result in a fall, such as eliminating scatter rugs and any obstacles between bedroom and bathroom, and installing night-lights.

 For weight gain: Instruct to watch the pts calories and exercise regularly to try to

prevent excessive weight gain. Fluid Retention and Elevated Blood Pressure low sodium diet check bp regularly Elevated bld. sugar monitor blood sugar regularly instruct pt. to follow the prescribed diet regimen Infection Avoid crowded places.

PHOTOS

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FROM GROUP 4