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PMR - The dangers of incorrect diagnosis

MagazineApril 1997 (Vol. 8 Issue 1)PMR - The dangers of incorrect diagnosis

Q:I have a friend who has gone blind because she has polymyalgia rheumatica and temporal arteritis, which was not diagnosed until it was too late to save her eyesight

Q:I have a friend who has gone blind because she has polymyalgia rheumatica and temporal arteritis, which was not diagnosed until it was too late to save her eyesight.

I have been told that this is a rare complaint which is difficult to identify. Would it be possible to alert your readers to the dangers of incorrect diagnosis? S C, North Tewkesbury, Glos......A:Polymyalgia rheumatica (PMR), an inflammation of the small blood vessels that supply the muscles, has been recognized as a disease only since 1969. Its cause is unknown, and its symptoms are non specific and include stiffness and aches. It is not dangerous unless the temporal arteries (at the sides of the head) become inflamed (temporal arteritis) in which case there is an increased risk of blindness. PMR is frequently associated with temporal arteritis, and some have posed the possibility that the two diseases may be one and the same.

It's a chronic rather than progressive disorder thought to be related to the whole family of autoimmune disorders, which include systemic lupus erythmatosus (SLE) and rheumatoid arthritis.

Because its symptoms are non specific, treatment can vary wildly (Br J Rheum, 1994, 33(2): 152-6) and misdiagnosis is common. For instance, PMR can be caused by the use of drugs for other conditions quinidine, a common antiarrythmic, can bring on PMR like symptoms (Seminars Arth Rheum, 1995; 24(5): 315-22). It can also be confused with other rheumatic conditions as well as Lyme disease (Postgrad Med, 1995, 97(1): 161-4), bacterial endocarditis (Rhode Is Med, 1994; 779(1): 5-6) and lymph cancer (Ann Rheum Dis, 1993; 52(2): 158-60). In blood tests, your doctor would see PMR patients having a high erythrocyte sedimentation rate (ESR) as well as a high C-reactive protein rate (CRP).

According to WDDTY panellist Dr. Patrick Kingsley, careful review of a patient's history may also reveal important information. "For instance some patients get worse during the hay fever season. Stress can also play a major role in this condition."

PMR is usually treated with steroids. Given the fact that steroids are such powerful drugs, it makes sense to first choose a less aggressive method first.

High on our list of general recommendations would be eliminating coffee and tea and other products containing caffeine. Often PMR patients have an excess of calcium in relation to magnesium, so in addition to cutting out cows' milk products they would also need magnesium supplements.

Candida related complexes may also be involved, as well as food intolerance, and low stomach acid.

The opinion of many of our panel members, including Dr Melvyn Werbach, is that a multifactoral approach which includes diet as well as homeopathy (BMJ, 1989; 299: 365-6), massage (Scand Rhem J, 1986; 15(2): 174-8), electroacupuncture (BMJ, 1992; 305:1249-52), hypnotherapy (J Rheum, 1991; 18(1): 72-5) as well as osteopathy, auricular therapy, biofeedback and transcutaneous electronic nerve stimulation (TENS) is the best way of getting on top of this unpleasant condition. This would include the same recommendations we've given readers with lupus and MS (see vol 7 nos 9 and 11 for more suggestions).

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