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.

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. potentially foreign in origin. .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.

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

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

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

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

Imaging tests . These images may also help identify or rule out other causes of your symptoms .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.

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

ESR . fall in a test tube in one hour. . The distance indirectly measures the level of inflammation — the farther the red blood cells have descended.measures the distance red blood cells. 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. or erythrocytes (uh-RITH-roh-sites).

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

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

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

200 milligrams (mg) of calcium supplements  400 to 1.000 international units (IU) of vitamin D supplements .provide supplemental pain relief  Calcium and vitamin D supplements. NSAIDs .000 to 1.to help prevent osteoporosis induced by corticosteroid treatment. It is the recommended daily doses for anyone taking corticosteroids for more than three months:  1.

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 . Physical therapy .

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

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

sugar  monitor blood sugar regularly  instruct pt. For weight gain:  Instruct to watch the pt’s 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. to follow the prescribed diet regimen  Infection  Avoid crowded places. .

PHOTOS  .

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FROM GROUP 4 .

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