ArcaMax

DEAR DR. ROACH: I was recently diagnosed with polymyalgia rheumatica after weeks of intense muscle pain. I'm a 67-year-old female in otherwise good health. My doctor prescribed prednisone, which immediately eliminated the pain and allowed me to resume my everyday life activities pain-free. I have an appointment with a rheumatologist at the end of the month, but I value your medical opinion on this condition. -- D.R.

ANSWER: Polymyalgia rheumatica (PMR) is not an uncommon disease, yet I find that many people haven't heard of it. It's a disease that is most common in people in their 70s, more common in women, and almost never seen below the age of 50.

The main symptom is what you mentioned: muscle pain that begins suddenly, especially in the shoulders and neck but also in both hips in some people. The pain is much worse in the morning or after a period of inactivity, like a car ride. Although people have difficulty with routine activities like brushing their hair, there isn't weakness, just pain. The onset is usually sudden and severe, and other symptoms, like weight loss, fatigue and depression, sometimes accompany the aching and stiffness.

Laboratory testing for inflammation, such as the C-reactive protein test and the erythrocyte sedimentation rate, are almost always very high. The final part of the diagnosis is when treatment with prednisone or another steroid, even at a low dose, rapidly improves the symptoms.

There isn't a lot of doubt about your diagnosis, especially if your inflammation blood tests support it. However, your rheumatologist will ask you questions about another disease, giant cell arteritis (GCA), which often accompanies PMR.

Symptoms of GCA include headaches (especially along the temples), pain while chewing, or any change in vision, especially transient vision loss. Vision loss is a true medical emergency and needs immediate treatment with high-dose steroids, preferably intravenously, in order to prevent blindness, which is usually permanent. About 10% of people with PMR will develop GCA, and it may happen before, during or after the initial symptoms of PMR.

Treatment of PMR is usually with low-dose prednisone. Many people can be slowly tapered off of it after one to two years. A sizeable proportion requires longer treatment, and a third of people remain on the treatment after five years. Because long-term prednisone use has the potential for so many side effects (diabetes, high blood pressure, and osteoporosis among them), using a low dose and tapering off the steroids is important. A few people with PMR benefit from alternative treatments, such as sarilumab.

DEAR DR. ROACH: I'm a 75-year-old male in good health. I've been on blood thinners since 1998. For years, I had been on warfarin, which I tolerated well. In March 2023, my doctor switched me to Eliquis. One thing I noticed on Eliquis is that I don't bruise as easily as when I was on warfarin. Am I imagining things? -- L.J.

ANSWER: You aren't imagining things. Many people who switch from warfarin to a medicine like apixaban (Eliquis) notice less bruising, even though they both work by blocking blood-clotting factors. The effectiveness of warfarin varies with diet, and when the anticoagulant effect is high, bruising is more likely. By contrast, apixaban has a very consistent effect, so fewer people notice bruising.

Unfortunately, warfarin is still the best option for some conditions. With lupus anticoagulants, warfarin was found to be superior. In people with mechanical heart valves, medicines like apixaban aren't effective, so only warfarin is used.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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