A case I encountered this
summer represented one of the quickest medical turnarounds I’ve seen in my
years of practice. A patient had presented with profound fatigue,
pain across their hips and shoulders, and extreme stiffness, especially
noticeable first thing in the morning.
These symptoms had
been present for at least six months, maybe more, and had worsened to the point
of making everyday tasks extremely difficult, some even impossible – from
reaching for a shelf in the kitchen and standing from a chair, to simply
brushing their hair in the morning.
By the afternoon, most
of their symptoms had vanished. Their own diagnosis? “Getting on.” Age is common understandable conclusion, , and it’s a mistake many people reasonably make, which
often encourages them to put their worsening symptoms to one side, and just get
on with it. In fact, the patient had polymyalgia rheumatica, or PMR, a
condition which can present abruptly or insidiously, and progressively interfere with daily life.
PMR is a common
inflammatory disorder that can often be effectively treated with
corticosteroids once recognised. It affects nearly 1 per cent of the UK
population, and women are two to three times more likely to be affected than
men. It’s also a condition associated with ageing : it’s exceptionally rare to see it in patients under
50.
The condition rarely
improves on its own, and if left untreated can worsen and become increasingly
disabling – potentially restricting both mobility and independence.
The associated
symptoms could also reflect a range of other inflammatory or indeed autoimmune
conditions, many of which are becoming increasingly common. Possibilities
include rheumatoid arthirities , myositis (another inflammatory muscle condition), even an under active thyroid gland..
One of the telltale
signs pointing towards PMR is that steroids often bring about striking
improvement and significant relief soon afterwards – usually within a few days.
This particular patient was suddenly able to resume activities they’d been
incapable of doing for months.
Whilst this represents
a much swifter response than most, it just goes to show that (in some
instances) there is such a thing as a quick fix. But in order to get there, you
need to be able to recognise the true nature of certain symptoms.
So, how can you guage
whether vague symptoms might signal a diagnosis of something inflammatory or
autoimmune?
When inflammation goes awry
Firstly, it’s helpful to define these two
conditions. Inflammation despite its association with disease, , is often a good thing. It’s part of the
normal response by which damaged body tissues heal, or fight infection. Immune
cells, including white blood cells, are attracted to the site of an injury,
which initiates the repair process.
bleeding or kidney injury. This means
that their use is best restricted to short periods, or with medical supervision
when needed for longer.Non-steroidal anti-inflammatories (NSAIDs) such as
ibuprofen and naproxen can indeed prove useful in treating some inflammatory
conditions, but they are not suitable for everyone. and long-term
use increases the risk of side effects such as stomach irritation, bleeding or
kidney injury. This means that their use is best restricted to short periods,
or with medical supervision when needed for longer.
Other medications can
suppress inflammation more powerfully. Corticosteroids are central to treatment
of PMR, gout and inflamatory bowel disease, – but can also cause significant side effects, and again must be managed carefully.
Inflammatory disease
can behave differently between patients: it can also come and go, necessitating
on-off periods of treatment – or be persistent, requiring more consistent
medication.
And treatment is not
just about alleviating symptoms, but also reducing the risk of complications.
Take rheumatoid arthritis, which can erode and deform joints, as well as affect
the heart, lungs and eyes if inflammation is left untreated. PMR is closely
associated with another inflammatory condition, giant cell arteritis, or GCA –
which requires urgent treatment because it can threaten eyesight. New
headaches, scalp tenderness, jaw pain when chewing, or changes in vision
alongside PMR symptoms therefore need prompt medical attention.
Does your lifestyle affect inflammation?
The overall effect of lifestyle on
inflammation is often bandied about on social media, but clinical evidence is
less convincing. There may be some beneficial effect to simple measures like
exercise, good sleep and not smoking – and adopting healthy diet patterns, like the mediterraneon diet, .
However, evidence for individual “anti-inflammatory foods” is limited, or
inconsistent. And when it comes to managing an inflammatory condition such as
PMR (and many others), lifestyle measures alone are not going to cut the
mustard – treatment with medication is necessary, and can’t be replaced by
diet.
So, the message with
inflammation and autoimmunity is not to push symptoms to one side, or
automatically attribute them to something else – but notice when they’re not
going away, have become more severe, or are starting to affect your life in
ways they clearly weren’t before.
Prompt diagnosis can
make a real difference. The answer may not always be a simple fix, or one that
has you feeling better by the same afternoon – but the route to recovery
becomes much clearer when both you and your doctor can see the wood for the
trees. Or, to put it in more inflammatory terms, the sometimes cryptic cause
behind the “-itis”. by Dr Dan Baumgardt
