The Difference Between Fibromyalgia And Polymyalgia Rheumatica

I am a registered nurse who has been diagnosed with fibromyalgia. My doctor has now mentioned polymyalgia rheumatica. I can’t find any information on the latter. Why can I not get medicine for pain? I, as a RN, understand their rationale, but is it good medical practice to let me suffer like this? I am on Elavil, 100 milligrams (mg) at bedtime. This works fine — except when I have a flare-up. Also, I have seen a rheumatologist who won’t give me anything stronger than Darvocet, which does nothing for me. Should I seek other medical advice?

Polymyalgia rheumatica is a poorly defined syndrome which can often be confused with fibromyalgia. It may also look like rheumatoid arthritis, and some experts believe that it is at least as common as rheumatoid arthritis in people over the age of 50. It is virtually never seen in people under that age.

The condition is more common in women. It may begin abruptly or be slow in onset, and the major symptoms are pain and stiffness in the muscles and joints, particularly the joints closer to the center of the body such as the shoulders, hips and knees. However, involvement of the joints of the hands is often seen, leading to the confusion with rheumatoid arthritis, in which involvement of the fingers and wrists is typical.

For many years polymyalgia was thought to be part of another condition known as giant cell arteritis, that is an inflammation of the arteries in which giant cells are seen. Giant cell arteritis often affects the temporal arteries, causing headache, and can affect the arteries going to the eye, in some cases causing blindness. This arteritis is found in only about 20 percent of people with polymyalgia rheumatica.

No one knows the cause of polymyalgia, and there are few tests to confirm the diagnosis. The erythrocyte sedimentation rate (ESR) should be high, often very high, but this is also seen in rheumatoid arthritis. The test for rheumatoid factor in the blood should be negative, but unfortunately that can also be true in some cases of rheumatoid arthritis. One distinct difference between the two is that polymyalgia is not known to damage the joints over time, which is typical of rheumatoid arthritis.

Polymyalgia is also different in that it appears to be very sensitive to cortisone-type drugs, often at very low doses. Typically a person with the condition will become pain-free in 24-48 hours on a modest dose of prednisone, say, 10-15 mg per day, and may be controlled on a dose of 5 mg per day. This is important, as the dosage of prednisone that will cause long term side effects is usually taken to be more than 7.5 mg per day. In other words, on 5 mg per day the risk of side effects from long term use of the drug is much reduced. Prednisone may be tapered after a year or so as a trial to see if the pain returns. Non-steroidal anti-inflammatory agents (NSAIDS) can also be taken, and there are new ones just approved by the FDA which are said to cause many fewer stomach problems than the old ones such as ibuprofen or aspirin. These are celecoxib (Celebrex) and rofecoxib (Vioxx). For a patient of mine I would certainly prefer one of these to the Darvocet that today’s writer is taking.

Since I don’t know our writer’s age or other facts about her history and examination, I can’t really say if she might have polymyalgia instead of fibromyalgia, but if her ESR is elevated, and her age is right, and her symptoms are primarily in the large joints, shoulders and hips, then a trial of prednisone could be justified.

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