Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Polymyalgia rheumatica (PMR) is a disorder of the muscles and
joints characterized by pain and stiffness, affecting
both sides of
the body, and involving the shoulders, arms, neck, and buttock
areas.
Patients with polymyalgia rheumatica are typically over the age
of 50
years.
What causes polymyalgia rheumatica?
The cause of polymyalgia rheumatica is not known. Recent
research has
indicated that genetic (inherited) factors play a role in who
becomes
afflicted with the illness. Theories have included viral
stimulation of
the immune system in genetically susceptible individuals. Rarely, polymyalgia rheumatica is associated with a cancer. In this setting, the cancer may be initiating an inflammatory immune response to cause the polymyalgia rheumatica symptoms.
What are symptoms of polymyalgia rheumatica?
The onset of the illness can be sudden. A patient may have a
healthy
history until awakening one morning with stiffness and pain of
muscles and
joints throughout the body. These symptoms persist and are often
accompanied by an intense sensation of fatigue. Some patients
notice a
gradual loss of appetite, weight, and energy. Depression can
occur.
How is polymyalgia rheumatica diagnosed?
The doctor frequently notes muscle tenderness and that the
motion of the
shoulders is limited by pain. The joints are usually not
swollen. However,
swelling of the small joints of the hands, wrists, and/or knees
can occur.
Blood testing for inflammation is generally abnormal, as
indicated by a
significant elevation in the erythrocyte sedimentation rate
(ESR) and/or C-reactive protein. There
are no specific tests, however, for polymyalgia rheumatica and
X-rays are
normal. The diagnosis is based on the characteristic history of
persisting
muscle and joint pain and stiffness associated with
elevated blood tests for inflammation, such as the ESR. It is also not unusual for patients to have slight elevations of liver blood tests.
Polymyalgia Rheumatica - Symptoms At Onset Of DiseaseQuestion: The symptoms of polymyalgia rheumatica can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
A sedimentation rate is common
blood test that is used to detect and monitor inflammation in the body. The sedimentation rate is also called the
erythrocyte sedimentation rate because it is a measure of the red blood cells (erythrocytes) sedimenting in a tube over a given period of time. Sedimentation rate is often
abbreviated as sed rate or ESR.
How is a sedimentation rate performed?
A sedimentation rate is performed
by measuring the rate at which red blood cells (RBCs) settle in a test tube. The
RBCs become sediment in the bottom of the test tube over time, leaving the blood
serum visible above. The classic sedimentation rate is simply how far the top of the RBC
layer has fallen (in millimeters) in one hour. The sedimentation rate increases with more inflammation.
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