Vital Role of Medication Therapy Management During Polymyalgia Rheumatica Treatment
Not long ago, scientists verified that older people who feel young and healthy actually do live longer—which means that nothing will shorten a life expectancy faster than polymyalgia rheumatica. Imagine going to bed feeling great, then waking up with such pain and stiffness you can’t bear to roll over and stand up. Talk about suddenly feeling very old!
The good news is that polymyalgia rheumatica is treatable. On the flip side, treatment means taking corticosteroids daily for one to three years. These patients need pharmacists who understand the illness and use medication therapy management to monitor for adverse effects while encouraging them to stick with treatment until they kick the disease.
Polymyalgia Rheumatica Facts and Symptoms
In a list of the most common autoimmune rheumatic diseases, rheumatoid arthritis has the top spot and second place goes to polymyalgia rheumatica (PMR). Like rheumatoid arthritis, PMR is marked by pain and stiffness and it also occurs more often in women than men, but otherwise it has a different clinical presentation:
- Involves large joints and periarticular structures—tendons, ligaments, bursa, bone, muscles, nerves, and fascia—rather than the joint capsule.
- Average age at diagnosis is 70 but it may appear any time after the age of 50.1
- Onset is usually rapid.
- About half of patients with PMR experience low-grade fever, fatigue, anorexia, and weight loss.
The primary symptoms of pain and stiffness are localized to:2
- Bilateral shoulders and upper arms (in almost all patients)
- Bilateral hips and thighs (in 70 percent of patients)
- Neck (in 50 percent of patients)
Patients with PMR always feel worse after rest or inactivity, with stiffness that lasts longer than 30 minutes. While symptoms should gradually improve as they get up and start moving, limited range of motion interferes with normal activities like getting dressed. Pain throughout the night also means these patients are likely to be sleep deprived.
What Pharmacists Need to Know, Beyond the Basics
It’s important to know the symptoms of PMR so you can educate patients who ask about their shoulder and hip pain or who take medications for the condition. However, there are two other pieces to the puzzle that should be part of the conversation when you have the opportunity to counsel patients: Their risk for developing giant cell arteritis and a clear picture about treatment.
Treatment reality vs online information – You already know that patients search for health information on the Internet. When they look up PMR, they’re going to find variations of these statements, which come straight from online sources:
- The symptoms are quickly controlled by treatment with corticosteroids.
- Luckily, PMR is easily treated.
- With treatment, polymyalgia rheumatica usually disappears in a day or two. Without treatment, it usually goes away after a year or more.
- PMR usually resolves within one to several years.
While all of the statements are mostly true, they convey a false reality. Symptoms do dramatically improve shortly after treatment begins, but they reoccur if treatment stops. For this reason, patients need to stay on the medication regimen for years until their PMR resolves. Motivating adherence under this scenario is a challenge, to say the least, which makes regular medication reviews critical.
Giant cell arteritis – Roughly 25 percent of patients with PMR will develop giant cell arteritis (GCA), while about half of all patients with GCA have PMR. Giant cell arteritis causes inflammation of the large arteries in the head—usually the superficial temporal arteries—and can result in blindness, stroke, or aortic aneurysm. Even though physicians should screen their PMR patients for GCA, some of the patients you’ll encounter haven’t been to the doctor. Pharmacists should be prepared to assess for these symptoms:
- Scalp tenderness
- Jaw claudication
- Vision loss
- Upper or lower extremity claudication
Overview of Treatment for Polymyalgia Rheumatica
Treatment of PMR consists of low-dose corticosteroids, usually 10 to 20 milligrams of prednisone daily. Pain and stiffness should improve by 50 to 70 percent within a few days.3 If the patient isn’t better within a few weeks, it’s highly probable that they do not have PMR. After symptoms have resolved, the dose is titrated down to find the lowest dose that keeps the patient comfortable.
Some may be able to stop taking corticosteroids within a year while others will need to stay on the regimen for two to three years to control pain and stiffness. Be sure to ask whether pain is under control; it’s essential to prevent levels of chronic pain that can cause central sensitization.
Even on a low maintenance dose, corticosteroids are associated with adverse effects that require the ongoing supervision of a doctor. When patients come in for refills, make it a point to ask about adherence and side effects and urge them to keep all appointments. Monitor for the following side effects:
- Hyperglycemia – monitor for signs of diabetes
- Weight gain
- Sleep deprivation
- Thinning and bruising of skin
- Puffiness of the face and neck
- Muscle weakness
Physicians may recommend non-pharmacologic treatments such as:
- Physical therapy – Helps older adults safely regain strength and coordination
- Low-impact exercise – Swimming and walking help reduce pain
- Calcium and vitamin D supplements – Prevent osteoporosis caused by corticosteroids
- Assistive devices – Reaching aids, shower grab bars, walking aids and grocery carts are just a few of the devices that make daily activities easier.
Counseling to Promote the Health of Elderly Patients
Remember that your patients with PMR are at least 50 years old and most are closer to 70, which means they come with unique health needs. They depend on regular medication therapy management to oversee polypharmacy. It’s also important to encourage them to stay active to relieve PMR symptoms and prevent frailty. Some may find it easier to exercise when they use topical medications to help reduce inflammation and relieve pain, so don’t hesitate to make recommendations. Reach out as an active member of the health care team and you’ll significantly improve their quality of life.
Pharmaceutica North America provides diverse prescription drug products, bulk APIs and natural OTC supplements for seniors and patients of all ages. Contact us today to talk about how we can support your pharmaceutical needs.
- “Polymyalgia Rheumatica Overview,” November 2015, http://www.practicalpainmanagement.com/patient/conditions/rheumatoid-arthritis/polymyalgia-rheumatica-overview ↩
- “Latest Advances in the Diagnosis and Treatment of Polymyalgia Rheumatica,” November 2015, http://www.practicalpainmanagement.com/pain/myofascial/inflammatory-arthritis/latest-advances-diagnosis-treatment-polymyalgia-rheumatica ↩
- “Clinical Manifestations and Diagnosis of Polymyalgia Rheumatica,” September 2014, http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-polymyalgia-rheumatica ↩