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.
The treatment of polymyalgia rheumatica is directed toward
reducing
inflammation. While some patients with mild symptoms can
improve with
nonsteroid antiinflammatory drugs such as aspirin or ibuprofen
(Motrin,
Advil), most patients respond best to low doses of cortisone
medications
such as prednisone or prednisolone. Not infrequently, a single
day's
cortisone medication eases many of the symptoms! In fact, the
rapid,
gratifying results with low dose cortisone medications is
characteristic
of polymyalgia rheumatica.
The dose of prednisone is gradually reduced while the doctor
monitors
the symptoms and normalization of the blood ESR. Reactivation
of symptoms
can require periodic adjustments in the prednisone dosage. Most
patients
are able to completely wean from prednisone within several
years. Some
patients require longer term treatment. Occasionally, patients
have a
recurrence years after the symptoms have resolved. The ideal
prednisone dosing regimen continues to be sought by researchers.
What is the prognosis for patients with polymyalgia
rheumatica?
The prognosis for patients with isolated polymyalgia
rheumatica is
ultimately very good. Polymyalgia rheumatica can occur in
association with
giant cell arteritis (see below). It can also occur, as mentioned above, in association with a cancer. The prognosis in this setting is based on the ability to cure the cancer. The polymyalgia rheumatica symptoms resolve with resolution of the cancer.
One of the keys to successful treatment of polymyalgia rheumatica is gradual, and not rapid, tapering of the medications. This can avoid unwanted flare-ups of the disease.
Because the medications prednisone and prednisolone are associated with potential bone toxicity, causing osteoporosis, patients should consider calcium and vitamin D supplementation. Women should have bone mineral density testing, and osteoporosis medications, such as estrogen, alendronate (Fosamax), and risedronate (Actonel) are considered.
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).
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