Aging Begins at 30

Sore Shoulders in Elderly Women

Some women, more often then men, age 60 to 70 complain of difficulty combing their hair and rising from the bed or chair. They may be fatigued and have lost weight. Aching to severe pain with tenderness occurs in their neck, shoulders, upper arms, hips and thighs. Some patients have pain on chewing. Maybe it starts on one side but in a few weeks both sides are involved. Movement becomes difficult in the morning or after periods of inactivity. There may be fever and depression. Headache is common.

The disease is almost unknown in blacks and in persons under 50. This illness was described by Dr. Bruce at Strathpepper Spa in Scotland in 1888. He called it senile rheumatic gout, but it has gone under many names. Since 1959 it has been called polymyalgia rheumatica or PMR.

Diagnosis is by excluding other diseases and by an unusual clue. The sedimentation rate of anticoagulated red blood cells in a 200 mm tube is normally 20 millimeters or less in one hour. In this disease the rate is 40 mms or sometimes more than 100.

The disease is self-limited lasting a year with a range of 2 to 54 months. It does not shorten life, but treatment is needed to control pain and to prevent a serious complication.

In 1890, Jonathan Hutchison, a surgeon at the London Hospital, described an elderly hospital aide who could not wear his hat because of painful red inflamed arteries in both temples. Now we call this temporal arteritis. About 20% of PMR patients develop inflamed arteries including those which supply the eyes. Severe headache, jaw pain, and trouble seeing are common. Of patients with these symptoms about 12% can suddenly become blind in an eye because the blood in the inflamed end-vessels has clotted. This can be followed by blindness in the second eye if treatment is delayed. The doctor has to run scared and have a surgeon sample (biopsy) a 3" length of scalp artery so the pathologist with the microscope can find diagnostic wall inflammation distributed here and there.

The aching muscles of PMR respond rapidly to 10 mgms of prednisone daily by mouth, but the biopsy-proved head vessel inflammation requires 60 mgms daily initially, (later gradually tapered.) Some milder shoulder aches can be managed with aspirin or nonsteroidals (like ibuprofen), but most doctors prefer prednisone. High dose steroid treatment has complications, such as hypertension, increased infection, weight gain, or worsening of osteoporosis.

The pain will return if treatments are stopped. Many people have to be treated for at least two years. Relapse also occurs if treatment dosage is lowered too rapidly. At least a year of follow-up is needed after treatment is stopped.

Polymyalgia is not a benign disease, but correctly treated it can be controlled.

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See related Patient Topics Bones, Joints and Muscles, Polymyalgia Rheumatica or Skin, Hair and Nails.

See related Provider Topics Bones, Joints and Muscles, Polymyalgia Rheumatica or Skin, Hair and Nails.

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