Polymyalgia often mistaken as arthritis
DEAR DR. DONOHUE: Both my shoulders started to hurt about a month ago. I thought it was arthritis. They were most painful and stiff early in the morning. The pain got so bad that I could hardly put on a shirt. I knew I had to get to the doctor, and I finally did. He took some tests and ordered an X-ray. It turns out I have something called polymyalgia rheumatica. The doctor wants me to take prednisone. I refused because I know what it can do to you. Is there any other medicine I can take? — R.K.
ANSWER: Polymyalgia rheumatica is something that happens only to people older than 50, and usually much older than 50. As many older people have it as do those who have rheumatoid arthritis. It’s not at all a rare thing. Its cause isn’t known.
The symptoms are much what you describe: pain and stiffness of the shoulders, hips, back and neck. All those places are not necessarily affected. The hands and feet might be slightly swollen. Symptoms are worse in the early morning, and people find it difficult to dress, comb their hair or fasten a bra.
Two lab tests help establish the diagnosis. One is the sedimentation, or sed, rate. It’s a simple test in which the patient’s blood is put in a calibrated tube. At the end of an hour, the distance the red blood cells have dropped from the top of the tube is measured. A high sed rate is standard for this illness. C-reactive protein, another detector of body inflammation, also is strongly positive.
If your symptoms are mild, then aspirin or other NSAIDs — nonsteroidal anti-inflammatory drugs — could relieve them. However, it would be wise to reconsider your position on prednisone, one of the cortisone drugs. When given in high doses for long periods, it has major side effects but polymyalgia doses are relatively small. The illness responds quickly to prednisone. If all goes well, the dose can be gradually reduced after two to four weeks even though treatment might last a year or more.
Another reason to consider prednisone is that polymyalgia is often accompanied by another inflammatory illness, temporal arteritis. If this illness isn’t treated quickly, it can cause blindness. Prednisone is its treatment.
DEAR DR. DONOHUE: I have on my face a number of unattractive blotches that my doctor says are actinic keratoses. He has told me I must see a dermatologist to get them removed. They don’t bother me, and at age 78 I am not going to enter any beauty contests. Do they have to be removed? — A.S.
ANSWER: Your doctor isn’t suggesting removal for cosmetic results. Actinic keratoses can turn into skin cancer. As their name suggests, they result from sun exposure. They can be pink, red or flesh-colored, and are about half an inch in diameter. Their surface is rough and scaly. They feel gritty, like sandpaper.
The dermatologist removes them in a number of ways, none of which is painful. He or she can freeze them with liquid nitrogen, scrape them with special instruments or apply 5-fluorouracil cream to them.
You should not ignore them or your doctor’s advice.
DEAR DR. DONOHUE: On the side of my eye, where the white of the eye meets the colored iris, I have a dirty-looking, spider-web-like affair. It doesn’t bother me. I just wonder what it is. What is it? — P.K.
ANSWER: In all probability it’s a pterygium (tuh-RIDGE-ee-um). It’s a triangular-shaped growth of tissues on the white of the eye in the 3:00 o’clock or 9:00 o’clock position. It’s gray in color and does appear like a thick spider web. If you look around, lots of people have one or two. It happens to people who spend lots of time outdoors — farmers, cowboys, sailors. If the pterygium extends onto the cornea, the clear dome that lies over the pupil, it can interfere with vision. An eye doctor can remove that if it ever happens.
I have to give the same warning to you that I give to others. Have this looked at by your family doctor.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.