Greetings, Dr. Roach After experiencing severe muscle discomfort for weeks, I was recently diagnosed with polymyalgia rheumatica. As a 67-year-old woman, my health is generally decent. Prednisone, which my doctor recommended, instantly took the edge off of my discomfort and let me get back to my regular activities without any problems. I appreciate your medical advice on this illness, but I have a rheumatologist appointment at the end of the month. — D.R.
RESPONSES: Although polymyalgia rheumatica (PMR) is a prevalent condition, I find that many individuals are unaware of it. The majority of patients with this condition are in their 70s, women are more likely to have it, and people under 50 are seldom ever observed.
The primary symptom is what you described: abrupt onset of muscular discomfort, particularly in the shoulders and neck, though some people also experience it in both hips. In the morning or following a period of inactivity, such as a car journey, the discomfort is significantly severe. There is only pain, not weakness, even when people struggle with daily tasks like brushing their hair. The onset is typically abrupt and severe, and the aching and stiffness can occasionally be accompanied by additional symptoms like sadness, exhaustion, and weight loss.
The erythrocyte sedimentation rate and the C-reactive protein test are two examples of laboratory tests for inflammation that are nearly always very high. When prednisone or another steroid, even at a low dosage, quickly alleviates symptoms, it is the last step in the diagnosing process.
If your inflammatory blood tests confirm your diagnosis, there isn’t much room for question. But your rheumatologist will query you about giant cell arteritis (GCA), another condition that frequently coexists with PMR.
GCA symptoms include headaches (particularly around the temples), chewing pain, or any alteration in eyesight, particularly temporary blindness. In order to prevent blindness, which is typically irreversible, vision loss is a serious medical emergency that requires prompt treatment with high-dose steroids, preferably intravenously. GCA may occur prior to, during, or following the onset of PMR symptoms, and it affects roughly 10% of individuals with PMR.
Low-dose prednisone is typically used to treat PMR. After a year or two, many people can be gradually eased off of it. A third of patients stay on medication after five years, and a significant percentage need extended care. It’s crucial to utilize a modest dose and go off the steroids because long-term prednisone use can have a lot of negative effects, including diabetes, high blood pressure, and osteoporosis. Some patients with PMR respond well to alternative therapies like sarilumab.
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Greetings, Dr. Roach I am a healthy 75-year-old man. Since 1998, I have been taking blood thinners. I had been taking warfarin for years, and I handled it well. My doctor switched me to Eliquis in March 2023. Eliquis has made me less prone to bruises than I was on Warfarin, which is one thing I’ve observed. Am I seeing things in my head? — L.J.
ANSWER: It’s not your imagination. Although both warfarin and apixaban (Eliquis) block blood-clotting factors, many people who transition from warfarin to these medications see less bruising. Warfarin’s efficacy varies with diet, and bruising is more likely when the anticoagulant effect is strong. However, because apixaban works so consistently, fewer people detect bruises.
Regretfully, for certain cases, warfarin remains the best choice. It was discovered that warfarin was better than lupus anticoagulants. Warfarin is the sole medication used in patients with mechanical heart valves because apixaban and other similar medications are ineffective.
Although he regrets not being able to respond to each letter individually, Dr. Roach will try to include them in the column. Questions can be sent by mail to 628 Virginia Dr., Orlando, FL 32803 or by email to [email protected].
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