Inflammatory soft tissue rheumatism in the elderly - polymyalgia rheumatica
Among rheumatic inflammatory diseases, joint inflammation is the focus of attention and arthritis is indeed the most common group in this area. Inflammatory soft tissue rheumatism is much rarer in comparison, but is no less burdensome for those affected than joint inflammation. In the first half of life, inflammatory connective tissue diseases (collagenoses) and inflammatory vascular inflammation (vasculitis) make up the majority of this group, with polymyalgia rheumatica accounting for the majority in advanced age.
This name already reflects the nature of this disease: those affected suffer from severe and widespread muscle pain, which particularly affects the shoulder and pelvic girdle. In contrast to age-related wear and tear diseases, in which the pain is more intense during exertion than at rest and tends to be more severe in the second half of the day than in the first, polymyalgia rheumatica has an inflammatory pain character with pain intensification at rest, at night and in the early morning, often combined with prolonged morning stiffness. The pain can be so severe that sufferers develop depression, stop participating in social life, lose weight and deteriorate mentally and physically within a few weeks.
The physical examination usually reveals no signs of joint inflammation and no signs of an infectious disease. Physical deterioration can lead to the suspicion of a tumor disease. A strong increase in inflammatory signs (erythrocyte sedimentation rate/BSG, C-reactive protein/CRP) is usually found in the laboratory. Beyond this, there are no laboratory findings that specifically support this diagnosis; positive rheumatoid factors or other serological findings such as antinuclear antibodies (ANA) are not associated with this disease. Polymyalgia rheumatica is a "clinical diagnosis", i.e. it is essentially based on the correct assessment of the description of symptoms and the physical examination. Diagnostic findings are only made in order to rule out other inflammatory diseases. If patients with this suspicion are registered with us, we try to make an appointment for a consultation as quickly as possible in order to shorten the path to diagnosis.
Another special feature of this disease is its rapid and thorough response to cortisone. Unlike other rheumatic inflammatory diseases, in polymyalgia rheumatica moderate doses of cortisone can eliminate the pain within hours to 1-2 days and relieve the patient from his desolate condition. Cortisone can then be rapidly reduced to a low dose at which side effects such as weight gain, increased blood sugar or blood pressure can usually be avoided. If the therapy is well controlled, cortisone can be gradually discontinued in the majority of patients during the second year of therapy without a relapse occurring. If the cortisone dose cannot be significantly reduced within a few weeks, a rheumatologist should be consulted, if this has not already been done, in order to clarify the cause of the increased need for therapy and possibly initiate a cortisone-sparing therapy with a second medication.
In some patients, polymyalgia rheumatica is associated with giant cell arteritis, a rheumatic inflammation of the arteries. The temporal arteries, the large arteries running to the head and arms and the aorta are particularly affected. This disease usually manifests itself through persistent headaches, pain in the chewing muscles, possibly an increase in temperature, in addition to extensive muscle pain. An unusually high cortisone requirement in the treatment of polymyalgia rheumatica also leads to the suspicion of concomitant arteritis. Emergencies with
