Polymyalgia Rheumatica

Polymyalgia rheumatica is a common condition that causes muscle pain and stiffness, especially in the shoulders. The onset is usually sudden, and it typically affects people over the age of 50. Polymyalgia rheumatica is sometimes related to another inflammatory disorder called giant cell arteritis –causing jaw pain, scalp tenderness, headaches and vision difficulties. Natural anti-inflammatory herbs and nutrients can help to provide relief from muscular pain and inflammation with minimal side-effects.

What are the symptoms?

The signs and symptoms of polymyalgia rheumatica usually affect both sides of the body and include:

• Muscle pain and stiffness in your shoulders (often the first symptom)
• Aches and pain in your upper arms, buttocks, hips, thighs or neck
• Stiffness that is worsened after periods of rest
• Limited motility in affected areas
• Periods of improvement and relapse

Other more general signs and symptoms include:

• Difficulty sleeping
• Fatigue
• Unintended weight loss
• Depression
• A general feeling of not being well
• Mild fever
• Loss of appetite

What are the causes?

Polymyalgia rheumatics is an autoimmune condition, where the immune system attacks the membranes lining the joint (synovium). This results in inflammation and swelling of certain joints such as the shoulders and hips. The exact reason why this happens in unknown, but several factors seem to be involved in the development of this condition.

• Genetics. Recent research has indicated that certain genes and gene variations may increase your risk.
• Environmental exposure. Some theories include viral stimulation of the immune system. However, no specific virus has been found to trigger the condition.
• Age. Polymyalgia rheumatica mainly occurs in the elderly, especially over the age of 65. It is rarely seen in people under 50 years of age.
• Gender. Women are more likely to develop the condition compared to men.
• Ethnicity. Caucasians (white) people are more susceptible.
• Giant Cell Arteritis

Approximately 20% of people with polymyalgia rheumatica have signs and symptoms of giant cell arteritis. It is believed that they may be the same disease but with different manifestations. Giant cell arteritis results in inflammation of the lining of the arteries, particularly those located in the temples. Symptoms include headaches, jaw pain, vision problems and scalp tenderness. If left untreated it can result in blindness or stroke.

Reducing pain and inflammation naturally

There are many natural options available to help provide relief of pain and stiffness. Many are suitable to use in conjunction with non-steroidal anti-inflammatories and prescription medications, but it is best to check with your doctor or naturopath first before supplementing.

Fish oil

Omega-3 polyunsaturated fatty acids have well documented anti-inflammatory properties, and consequently therapeutic potential in chronic inflammatory diseases. They play a role in reducing a variety of inflammatory pathways which can results in improved joint and muscle pain. Fish oil has not been clinically researched for polymyalgia rheumatica but it’s benefit has been concluded in arthritis, rheumatoid arthritis and vascular diseases.

The best way to take fish oil is through a reputable company and in a concentrated form.

Magnesium

A deficiency of magnesium can result in inflammation, high blood pressure, cardiovascular disease and musculoskeletal pain. Supplementation with magnesium may help to relieve muscle tension, reduce pain, increase energy and improve sleep. Increasing dietary concentrations of magnesium is important also. Magnesium rich foods include spinach, pumpkin seeds, natural yoghurt or kefir, almonds, bananas and avocados.

Turmeric

This humble spice provides powerful anti-inflammatory support to both muscles and joints. The best way to take this supplement is in a concentrated form rather than just in cooking. Curcumin is the active constituent of turmeric which provides the body with antioxidant support as well as reduced joint and muscular inflammation. Unfortunately, no studies have been done on turmeric in polymyalgia rheumatica, but many studies have proven it beneficial for other arthritic and autoimmune conditions that share similarities such as rheumatoid arthritis. Turmeric may be suitable in individuals who also have giant cell arteritis as turmeric has been found to be helpful in individuals who suffer from a similar condition called Takayasu arteritis. 

Calcium and vitamin D

Corticosteroids are the drug of choice to treat polymyalgia rheumatica, but the side effects include an increased risk of osteoporosis. To combat the side effect of decreased bone density a supplement containing calcium and vitamin D may be helpful. Up to 1200mg of calcium and 1000 IU of vitamin D may be recommended by your doctor.

B vitamins

They are usually found as a complex and are important for relieving fatigue, reducing muscle pain and supporting adrenals which are involved in the body’s natural production of anti-inflammatory substances.

Finding a formulation with an activated form of vitamin B6 called P-5-P is an advantage in reducing muscular symptoms. B vitamins are found in a variety of fruits, vegetables, meats, wholegrains, nuts, seeds and legumes.

It is important to eat a balance of these foods daily to ensure adequate amounts are obtained from the diet. 

Other healthy lifestyle choices include:

• Regular exercise. This can include a combination of different exercise such as weight-bearing, cardio, relaxation and stretching. Exercise helps to maintain a healthy weight, strengthens muscles and bones and improves mood.
• Physical therapy. This can be a good option for people who have had a long stretch of limited activity. Through a trained physiotherapist, specialised exercises can help to regain strength, coordination and the ability to perform daily tasks.
• Using assistive devices. They can help to make daily tasks that bit easier. Shower grab bars, reaching aids and even a walking aid to help minimise the risk of falls. Wearing comfortable, flat footwear with support will also help to minimise the risk.

References

1. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/polymyalgia-rheumatica
2. https://www.mayoclinic.org/diseases-conditions/polymyalgia-rheumatica/basics/definition/con-20023162
3. Jurenka JS. Anti-inflammatory properties of curcumin, a major constituent of Curcuma longa: a review of preclinical and clinical research. Altern Med Rev. 2009 Jun;14(2):141-53 https://www.ncbi.nlm.nih.gov/pubmed/19594223
4. Shao N, Jia H, Li Y, Li J. Curcumin improves treatment outcome of Takayasu arteritis patients by reducing TNF-α: a randomized placebo-controlled double-blind clinical trial. Immunol Res. 2017 Aug;65(4):969-974 https://www.ncbi.nlm.nih.gov/pubmed/28349250
5. Yates CM. Pharmacology and therapeutics of omega-3 polyunsaturated fatty acids in chronic inflammatory disease. Pharmacol Ther. 2014 Mar;141(3):272-82 https://www.ncbi.nlm.nih.gov/pubmed/24201219
6. Nielsen FH. Effects of magnesium depletion on inflammation in chronic disease. Curr Opin Clin Nutr Metab Care. 2014 Nov;17(6):525-30 https://www.ncbi.nlm.nih.gov/pubmed/25023192