Polymyalgia rheumatica (PMR) is a chronic inflammatory disorder primarily characterized by muscle pain and stiffness. It is a common rheumatic disease, particularly affecting older adults, with the average age of diagnosis around 70 years. Women are nearly twice as likely to develop PMR compared to men, and it rarely affects individuals younger than 50. While the exact cause remains unknown, it is considered an autoimmune condition. This article will explore the specific outcomes and potential health risks associated with leaving polymyalgia rheumatica untreated.
Understanding Polymyalgia Rheumatica
PMR is an autoimmune disorder where the body’s immune system mistakenly attacks healthy tissues, leading to inflammation in the joints and surrounding bursae, causing aches, pain, and stiffness, mainly in the shoulders and hips. Characteristic symptoms include severe morning stiffness, often prolonged, and pain that frequently worsens after periods of inactivity. These symptoms typically affect both sides of the body, including the neck, upper arms, and thighs, and can develop rapidly.
Individuals with PMR may also experience broader systemic symptoms, such as general fatigue, malaise, mild fevers, loss of appetite, and unintended weight loss. Diagnosis typically involves a clinical assessment of these symptoms alongside blood tests. Elevated levels of inflammatory markers like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are typically present, indicating systemic inflammation and helping rule out other conditions with similar presentations, such as rheumatoid arthritis.
Worsening of Core Symptoms Without Treatment
Leaving polymyalgia rheumatica untreated allows the primary symptoms to intensify and become more debilitating. The pain, which initially might be localized, can progressively increase in severity, becoming constant and more widespread, affecting additional muscle groups like the lower back and thighs. This persistent discomfort can make even simple movements challenging, reducing overall physical comfort and making comfortable positioning difficult.
Morning stiffness, a hallmark of PMR, can extend beyond the initial 45 minutes without intervention. It may persist for much of the day, severely limiting mobility and flexibility, restricting movement such as turning in bed or getting out of a chair. This prolonged stiffness can hinder an individual’s ability to perform routine activities, such as dressing, bathing, or combing hair. The restricted range of motion in affected areas like the shoulders and hips becomes more pronounced over time, potentially leading to a reduced capacity for self-care.
The fatigue associated with PMR also escalates when the condition remains unmanaged. This can lead to profound exhaustion that impacts daily functioning and overall energy levels, making even light activities feel overwhelming. Many people with untreated PMR find their ability to move freely and manage their own care significantly compromised, often requiring assistance from others.
Major Health Risks of Untreated PMR
A significant concern with untreated polymyalgia rheumatica is its strong association with Giant Cell Arteritis (GCA), also known as temporal arteritis. GCA is a distinct, severe inflammatory condition that affects arteries, particularly those in the head, but also other medium and large blood vessels, including the aorta. Approximately 15% to 20% of individuals with PMR will develop GCA, while about half of patients with GCA also experience PMR symptoms, highlighting their close link.
The symptoms of GCA demand immediate medical attention due to their potential for irreversible consequences. These include new onset headaches, often severe, persistent, and localized to the temple area, sometimes accompanied by scalp tenderness. Jaw pain that occurs with chewing or opening the mouth wide, known as jaw claudication, is another characteristic symptom indicating reduced blood flow. GCA can cause sudden vision loss or double vision, which can become permanent if not treated promptly, as blood supply to the optic nerve is compromised. Untreated GCA can also lead to more widespread vascular damage, increasing the risk of stroke.
Beyond GCA, chronic, untreated inflammation from PMR can contribute to other systemic effects. Individuals may experience an increased risk of anemia, characterized by a reduced number of red blood cells and persistent tiredness. Unexplained weight loss, often accompanied by a general feeling of being unwell, can also become more pronounced without treatment. While less common, PMR can sometimes cause inflammation of the body’s largest artery, the aorta, potentially leading to a life-threatening aortic aneurysm.
There is also an increased predisposition to cardiovascular issues and osteoporosis over time due to persistent inflammation. The ongoing inflammatory process can contribute to the development of atherosclerosis and potentially increase the risk of heart disease. Early diagnosis and treatment are important for managing PMR and mitigating the risk of these serious complications, especially the potentially devastating effects of GCA on vision and brain function.
Untreated PMR and Daily Living
The persistent pain, stiffness, and profound fatigue associated with untreated polymyalgia rheumatica can severely limit physical activity. Routine tasks, such as dressing, bathing, combing hair, and walking, become increasingly challenging or even impossible. This profound impact on physical function often results in a significant loss of independence, as individuals struggle with basic self-care activities. They may find themselves requiring substantial assistance from family or caregivers for everyday needs.
The inability to engage in everyday life can take a substantial psychological toll. Chronic pain and restricted mobility contribute to an increased risk of depression, anxiety, and a diminished sense of self-worth. The constant discomfort and the frustration of being unable to participate in hobbies, social gatherings, or work activities can lead to profound feelings of isolation and loneliness. This can further exacerbate mental health challenges, creating a cycle where physical symptoms worsen emotional well-being, impacting overall mental resilience.
The overall quality of life diminishes considerably without intervention for PMR. Sleep patterns are often severely disrupted by pain, leading to further fatigue, irritability, and a general feeling of being unwell. The condition can strain personal relationships, hinder professional pursuits, and limit participation in community life. The potential for long-term disability is a serious outcome when PMR is left unmanaged, significantly impacting an individual’s independence and quality of life.