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Treatment | Polymyalgia Rheumatica |PMR
What can I do about PMR?
Being diagnosed with a chronic disease like PMR can be a little scary. The first thing is don’t panic. Take a deep breath. Although you might have been diagnosed with PMR, you are not alone. Luckily, there are effective treatments available. They can make living with the condition much more comfortable.
If you have PMR or think you may have PMR, see your family doctor. In many cases, your family doctor can help you manage the pain and stiffness. Your family doctor might refer you to a rheumatologist or wait a while to see if the PMR goes away. A rheumatologist is a specialist doctor who is an expert in treating arthritis.
Here are some recommendations on what you should do if you have PMR:
- Learn as much as you can about this disease. Education is very powerful and we’ve aimed to develop this RheumInfo website to be accessible and easy to understand for everyday people living with PMR and other forms of arthritis
- Attend your family doctor and/or rheumatologist appointments regularly
- Get your blood tests done as suggested by your doctor or rheumatologist
- Learn about the medications used to treat PMR. The RheumInfo website has many interactive and valuable tools to help you understand these medications and their impact on your disease
Treatment of PMR
PMR can be fully and effectively treated with the right therapy. This means people with PMR can return to their normal day-to-day lives. Treatment of PMR usually involves both medications to address the inflammation as well as physical therapy to keep the joints moving properly.
If you have PMR, it’s important to treat it early. The longer you wait, the more difficult it can be to fully regain a normal range of motion in your shoulders and hips. There are effective treatments for PMR – so don’t wait around, get it treated appropriately.
Why is it important to treat PMR early?
The pain and stiffness associated with PMR can be debilitating. If left untreated, chronic pain and stiffness can cause a person to change their habits to protect their sore joints. For example, you might find that you stop lifting your arms above your head. The problem is that over time, limited movement can lead to a “contracture” – permanent shortening of a muscle or joint. Once this happens, the damage cannot be undone. That’s why it’s best to treat PMR early, so that you can maintain the range of motion in your shoulders and hips.
Medications for PMR
Prednisone is the main medication used to treat PMR. It works by fighting the inflammation caused by PMR. In most people, symptoms are noticeably better within 24 hours. Your doctor may also recommend other medications instead of or in addition to prednisone.
For more information about specific medications used to treat PMR, refer to the “pictopamphlets” in the Medications section of RheumInfo.com.
Medications like prednisone can help control inflammation. Prednisone is a very effective medication to control the symptoms of PMR. In some people with PMR, stiffness completely disappears after just one dose.
Once the symptoms of PMR are under control, the dose of prednisone is gradually reduced. People with PMR usually have to continue taking a low dose of prednisone for at least 1 year to prevent the inflammation from returning.
Stopping prednisone completely can be difficult for some people. That’s because the inflammation can return if prednisone is stopped too soon. If you’re having trouble coming off prednisone, your doctor or rheumatologist might recommend other medications such as NSAIDs or DMARDs to make it easier.
When used for long periods of time, corticosteroids can have side effects. People who take corticosteroids for 3 months or longer are advised to take a daily calcium and vitamin D supplement to protect their bones. Sometimes other medications are also recommended for bone protection. You should discuss the risks and benefits of using prednisone with your family doctor or rheumatologist.
Non-Steroidal Anti-Inflammatory Drugs or NSAIDs are medications that may help to reduce the inflammation caused by PMR. They also help to reduce symptoms such as pain. NSAIDs are usually not as effective as prednisone for the initial treatment of PMR. If you still have stiffness and pain after starting prednisone, your doctor may suggest you take an NSAID as well. If you have been taking prednisone for a long time, taking an NSAID may help you reduce your dose of prednisone.
Analgesic medications only control pain. They do nothing to control the disease or to prevent further joint damage. Analgesics can range from simple things like acetaminophen (Tylenol) to more potent narcotics like morphine.
The Disease Modifying Anti-Rheumatic Drugs (DMARDs) are medications that are used for other types of inflammatory arthritis such as rheumatoid arthritis. Taking DMARDs called methotrexate or plaquenil can help some people reduce their dose of prednisone.
Exercises for PMR
Physical therapy and exercise are an important part of your overall treatment plan. The right exercises can actually improve the pain and stiffness in your shoulders and hips. They can also reduce fatigue and the emotional distress of PMR. Physical therapy and exercise can help protect the joints by strengthening the muscles around them. They should be done daily to derive the maximum benefit.
A trained arthritis physiotherapist can help design an exercise program to return your shoulders and hips to their full range of motion.
Natural or Home Remedies for PMR
There are no known natural remedies or complementary therapies that have been proven to help PMR in any significant way. Some plants contain “natural steroids” that supposedly improve PMR. But if it sounds too good to be true, it probably is!
Nevertheless, if you choose to use natural remedies or complementary therapies, you should check with your doctor or rheumatologist. Some medications may interact with these products.
Diet for PMR
Questions about diet and arthritis are very common. We all want to know what we can do to help ourselves. Can we change our diet to help our arthritis? Changing our diet gives us a sense of control over a disease which often seems to have a mind of its own.
Unfortunately, there is no diet that has been proven to significantly alter the course of PMR or other types of arthritis. Following the basics of healthy eating can help improve health and well-being in everyone, including those with PMR.
Taking prednisone for long periods of time can result in weight gain. Eating a healthy diet and getting regular exercise can help you maintain a healthy weight.
Alcohol and PMR
Many of us like to share a glass of wine, a beer, or a spirit from time to time. Unfortunately, due to the nature of PMR, some people may turn to alcohol to help cope with the pain and distress. Alcoholic beverages are not an effective treatment for PMR. Sometimes, they can also interact with your medications.
Smoking and PMR
Cigarette smoking, whether you have PMR or not, has no positive effects on any aspect of your health. Smoking is recognized as a risk factor for heart disease. Many people who develop PMR are older and have other conditions that increase their risk of heart disease. These include high blood pressure, high cholesterol and diabetes. If you are a smoker with PMR, quitting could be one of the best things you can do to improve your overall health.