Polymyalgia rheumatica (PMR) is a relatively common cause of widespread aching and stiffness in older adults. PMR can overlap with another rheumatic disease called giant cell arteritis, and symptoms of the two conditions can occur at the same time or separately. (See p. 12 of the March 2008 issue for more on giant cell arteritis.) The typical symptoms of PMR include aching and stiffness around the upper arms, neck, lower back, buttocks, and thighs. Symptoms tend to develop quickly over a period of several days or weeks, and occasionally even overnight.
Osteonecrosis
Osteonecrosis, also called avascular necrosis or aseptic necrosis, is a condition in which the death of bone cells (due to decreased blood flow) can lead to pain and collapse of areas of bone. This collapse of bone, in turn, can lead to degenerative arthritis of nearby joints, most commonly the hips and knees. Less frequently affected are the shoulders, hands, and feet. In rare instances, osteonecrosis can occur in the jaw— resulting in pain and mouth ulceration. Osteonecrosis is not fatal, but can lead to pain, arthritis, problems with physical activity, and even the need for joint replacement. Most of the 10,000 to 20,000 Americans developing osteonecrosis annually are between age 20 and 50. These individuals usually have a history of serious trauma, corticosteroid use, excess alcohol intake, or other conditions including systemic lupus erythematosus, dysbarism (“the bends” that occur with scuba diving), blood disorders, HIV infection, and radiation therapy.
New and Updated Patient Education Materials Available
The ACR is continually updating and increasing its collection of patient education materials, or fact sheets. One of the newest fact sheets, “Pregnancy and Rheumatic Disease,” discusses the complex interactions of pregnancy and rheumatic diseases, acceptable medications to use during pregnancy and breastfeeding and helps to define what constitutes a high-risk pregnancy. The fact sheet offers links to additional resources and educational materials.