HEALTH MATTERS: A look at PMR and Parkinson’s
Q. For the past few months I’ve had aching of my shoulders and chest, and pain moving my arms. Nothing seems to help. Any ideas?
A. I recently saw a patient with similar complaints, and it turns out he has a relatively common condition called polymyalgia rheumatica, or PMR.
Polymyalgia means “pain in many muscles.” It causes symptoms like yours and often also affects the hips. The symptoms usually are worse in the morning and after periods of rest. It is an inflammatory disorder that mainly affects older adults and may be associated with inflammation in the medium-sized blood vessels in the body (the arteries).
This complication may be serious because in occasional cases it can lead to blindness. While the precise cause of PMR is unknown, the good news is it typically responds — usually dramatically — to low doses of a medicine called prednisone.
The results usually are so good that we question the diagnosis of PMR if a patient doesn’t respond promptly — typically within several days — to the initiation of prednisone treatment. While patients with PMR respond quickly to this treatment, it is often necessary to take prednisone for at least one year to decrease the chance that PMR will come back.
Unfortunately, the typical over-the-counter anti-inflammatory medications, with brand names such as Motrin, Advil and Naprosyn, are not particularly effective with PMR. One of the tip-offs to the diagnosis of PMR in patients with symptoms such as yours is an abnormally high reading on a blood test called an erythrocyte sedimentation rate, or ESR.
While such an abnormal test result isn’t conclusively diagnostic of PMR, it is quite suggestive. So, I’d suggest you see your health care provider soon, get fully evaluated and be sure you get an ESR.
Q. My grandfather has Parkinson’s disease. What is it and what treatment is available?
A. Parkinson’s disease is a common disease that typically affects older individuals and is marked by degeneration of specific cells in the brain that manufacture a chemical called dopamine. Thus, it is called a neurodegenerative disease, indicating that degeneration is occurring in brain cells.
It is the second most common neurodegenerative disease behind Alzheimer’s disease, which as you know leads to memory loss and impaired thinking. Parkinson’s disease differs in that it principally affects motor function (as a consequence of the interference with dopamine production), and leads to muscle tremor, trouble with ambulation, slowness of movement, rigidity of the extremities and speech impairment.
Unlike Alzheimer’s disease, impaired thinking is less common, especially in the early stages of the disease. While there is no cure for Parkinson’s, medications have clearly been shown to help reduce the motor impairment. Physical and occupational therapy also can help patients manage and adapt to their physical limitations and maintain independence as long as feasible.
Parkinson’s disease typically is slowly progressive, and medications tend to become less effective over time. In occasional cases, brain surgery may be an option, but not for most patients.
Wynne is vice president for health affairs at the University of North Dakota, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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