Polymyalgia rheumatica

How many minutes from waking until the shoulders move normally? That number is worth more in conversation than any description, and it also shows whether the treatment is working.

Under a low dose of cortisone it usually improves clearly within days. If that does not happen, the diagnosis is looked at again rather than the dose raised.

A new headache, pain on chewing, a visual disturbance. Knowing these three loses no time when it matters — and that is the decisive difference here.

A normal creatine kinase belongs to the picture. If it is raised, it is about a muscle disease or trouble under cholesterol-lowering drugs — a quite different treatment.

Resting deepens the stiffness and costs muscle — and muscle loss is a theme under cortisone anyway. Gentle daily movement belongs from the start.

Treatment often lasts one to two years. Calcium, vitamin D and a bone density measurement therefore belong in the plan, before anything happens.

A threadworm can stay silent in the gut for decades and flare severely under longer cortisone or immune therapy. Anyone who ever went barefoot in the tropics or subtropics is looked for beforehand with a blood test — one effort that prevents a great deal.

The response to low-dose cortisone is here almost part of the diagnosis: in most people the pain improves clearly within twenty-four to forty-eight hours. If it does not, the classification is reconsidered. Treatment runs one to three years with very slow reduction — reducing too fast is the most common reason for relapse. Because of the long cortisone use, bone protection and blood sugar checks belong to it.

Almost only people over fifty are affected; about fifty per hundred thousand a year. The stiffness in shoulders and hips lasts more than an hour in the morning and has been there for at least two weeks. The sedimentation rate is usually above forty millimetres in the first hour. Treatment runs one to three years; the dose falls by about a milligram every four weeks. In about one in five there is a giant cell arteritis at the same time.

Being on both sides is characteristic. A one-sided shoulder pain speaks rather for the tendons or the joint itself.

The duration of morning stiffness separates inflammatory from wear-related complaints. In osteoarthritis the stiffness eases within a few minutes.

Many can name the day or the week. A creeping onset over months fits less well.

Strength is preserved; it is the pain that limits movement. True weakness points in another direction and belongs clarified differently.

These three mean the related arteritis may have joined in. Then one does not wait until the next appointment.

Typically on both shoulders and hips, worst in the morning, with long-lasting stiffness. It affects almost only people over fifty.

Usually clearly raised and the value that accompanies the course. It falls under treatment and often rises again with a relapse.

Reacts faster than the ESR and is therefore better suited to short-term monitoring.

Normal here — and that is exactly the point. A raised value points to a muscle disease or to muscle trouble under cholesterol-lowering drugs.

An underactive thyroid causes muscle pain and stiffness and is separated with one value.

To separate a rheumatoid arthritis, which can begin very similarly in later life — there the small joints are usually involved as well.

With chronic inflammatory and autoimmune pictures low levels are common — partly because the illness itself lowers the level, partly because less time is spent outdoors. Whether correcting it changes the course is being studied; for bone and muscle it is worthwhile regardless.

They give rise to messengers that tend to end inflammatory reactions rather than fuel them. Oily sea fish twice a week is the simplest route; capsules are an option but replace no treatment.

The building material itself. Better from food than from a tin: hard cheese, yoghurt, calcium-rich mineral water, almonds, broccoli and fortified plant drinks.

Needed for steering the defences and for the healing of tissue. A lack is more common with chronic diarrhoea, little meat and pulses, and under cortisone.

Activates the proteins that build calcium into bone. Green leafy vegetables and fermented foods cover it — under coumarin blood thinning the amount stays steady rather than swinging.

Here it is about accompanying the cortisone treatment: 1000 mg a day from food and supplement together protects the bone while cortisone runs. It does not act on the illness itself.

For the same reason: 20–50 µg (800–2000 IU) a day belongs with cortisone treatment over months. Otherwise cortisone strips substance from bone quickly.

Effects on inflammation and triglycerides established; cardiovascular prevention is mixed. Watch quality and freshness.

Hardly any condition answers so unambiguously: on low-dose cortisone the complaints are usually gone within days. Exactly that counts as confirmation — if the improvement fails to come, the classification is usually wrong.

Cortisone over months breaks down muscle, especially in thighs and upper arms — exactly where the condition itself hurts. Strength training and enough protein work against it; that belongs in from the start.

Cortisone lowers calcium uptake in the gut, whereupon this hormone rises and takes calcium from bone. That is the route by which cortisone treatment costs bone — and the reason for calcium and vitamin D from the start.

Treatment often runs 1–2 years. In that time steroids pull calcium from bone and protein from muscle — 1000–1200 mg calcium, vitamin D by level and 1.2 g protein per kg a day is the usual frame.

Steroids hold water and drive sugar. Salt below 5 g a day and slow carbohydrates keep both flatter — especially in the first weeks at high dose.

On steroids muscle breaks down. Light strength training counters this and is possible despite the pain — adapted, not suspended.

As with any longer steroid treatment bone protection belongs from the start.

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