Polymyalgia Rheumatica - Another Atypical Case

Polymyalgia rheumatica (PMR) is a painful inflammatory and debilitating disease of the muscles and tissues surrounding the large joints.  Some people believe that this inflammation exists inside of the blood vessels (vasculitis) that feed these muscles and tissues.  The cause is unknown, however, a previous infectious process prior to the development of the disease is hypothesized. I saw a 49 year old man with a sudden onset of violent pain and stiffness in his shoulders, hips, hands, elbows and knees.  Previous to this, he was completely healthy and was regularly active in many sports including hiking, backpacking, snowboarding and basketball.

His condition deteriorated to the point that he could no longer get out of bed or out of a bathtub on his own without someone lifting him up.  He could not sleep at night due to the intensity of his pain.  This man was rapidly progressing to the state where he would soon require a wheelchair.

This rapid deterioration occurred over the span of 2 months.  Prior to the onset of his symptoms, he had a wisdom tooth extracted in which he developed an infection and severe pain at the site of the extraction.

In order to diagnose his severe musculoskeletal problem, he saw 2 MDs, had 7 X-rays done, and had a comprehensive laboratory workup completed, including a blood test for C-reactive protein and an ESR.  All tests came back negative, including the ESR and the test for C-reactive protein;  both of which are usually elevated in patients with PMR.

His doctors prescribed anti-inflammatory medications as well as analgesics that did nothing for his symptoms, and he continued to deteriorate rapidly.

I wondered if a diagnosis of PMR might be a possibility for this man, but he didn't fit the typical case of someone with this disease.  Most people with PMR are over 65.  Most are women.  The large majority will have some elevated inflammatory marker such as the sedimentation rate (ESR) or the C-reactive protein.

Nope.  He didn't fit any of the usual parameters.

I gave him a daily dose of Prednisone 20 mg (a steroid) to take for 3 successive days just for diagnostic purposes to see if my idea of PMR was valid.  Within 24 hours, his symptoms were relieved by about 50%, and within 48 hours his symptoms were relieved by about 90%.  He felt very close to being completely pain-free and had almost normal mobility again.  The change was dramatic, and my diagnosis of PMR, despite lack of confirmatory blood tests was indeed accurate.

For 2 months, this man was on a course of steroid therapy whereby the dose was gradually decreased until he was completely weaned off of the medication.  Many people with PMR need to take steroid therapy for a few years in order to continue feeling well.  While steroids are invaluable for the initial diagnosis of PMR and the quick return of  functioning in a person with this disease, steroids also have many difficult and challenging side effects when taken long-term.

While this man experienced enormous relief with the Prednisone, he also started developing unwanted symptoms such as mood changes and blood sugar fluctuations while on the drug.

It is my opinion that those with PMR would benefit tremendously from seeking out the advice and care of a naturopathic physician.  This link is for those who live in Canada.  The link for the US is here.

With naturopathic medicine, we were able to effectively wean this man off of the steroid after 2 months of use.  Because every patient is unique, each person requires an individualized program to manage his or her disease.

However, in general, adrenal function is often a key in the attainment of health in the patient with PMR.  Using anti-oxidant therapies for the vasculitis that is presumed to accompany PMR, is also quite helpful. Removing food allergies, food sensitivities and food intolerances is a must in order to decrease the body burden of inflammation in the PMR patient.

The following is what I prescribed for this man:

1)  strict adherence in avoiding food allergies and food intolerances

2)  Gamma Linolenic Acid (from borage oil) 480 mg twice daily

3)  Magnesium Glycinate 100 mg twice daily

4)  Multi Anti-Oxidant formula 1 capsule twice daily ("Super AO" from NaturPharm)

5)  "Multi-B5" (from Thorne) 1 capsule daily

6)  Vitamin E (in a mixed tocopherol formulation) 400 IU twice daily

7)  Grape Seed Extract 25 mg ("Grapenol" 85% Proanthocyanidins) twice daily

8)  Buffered Vitamin C 4 gm daily ("Scorbatate" from Genestra)

9)  much later, when his condition was stable off of the steroid:  Ashwagandha root along with other herbal medicines (as found in "Stress Calm" from WTS)

This was the regime this patient was on for 4 years, with minor changes I made here and there as was needed.  At present he takes no supplements for PMR, but continues to follow an anti-inflammatory diet.

With other PMR patients, I have sometimes used "Isocort" to help support the cortisol production of the body.  This particular adrenal support therapy was not indicated for this particular patient.

Again, I apologize for sounding like a broken record.  If you have PMR, it is very wise to seek out naturopathic care.

My patient has returned to his previous state of good health and once again participates in all of the sports he loved to do prior to his illness.

I suppose the take home messages from this case are as follows:  Not all cases of a disease "fit" the typical picture.  No matter what health issue you are experiencing, keep persisting until you get a proper diagnosis.  The earliest diagnosis and treatment of any disease is always best, and gives the greatest chance for maximal recovery.

I'm very thankful that this man was diagnosed early on, because he could have been sitting in a wheelchair now instead of doing lay-ups on the basketball court.  I'm thankful because I wish good health for all people.  I'm especially thankful because this man whom I have been writing about, happens to be my husband.