A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 39
PATHOLOGY PERSPECTIVES
prednisone or prednisolone to manage their
symptoms, and steroidal anti-inflammatory
use presents further concerns for massage
therapists. These drugs are extremely
effective for the management of both
conditions, but they are typically used for
several months, or maybe years. The side
effects of prednisone and prednisolone
involve issues that impact bodywork
choices, including easy bruising and an
increased risk of diabetes and osteoporosis.
See "Consequences of Long-Term Steroid
Use" for more on this topic. This doesn't
mean we can't work with clients who are
in treatment for PMR or GCA, but we do
have to make appropriate adjustments.
Do you have clients who are over 50? Do
they ever ask for your help with shoulder or
hip pain or headaches—especially with new
and worsening symptoms? If the answers
are yes, then PMR and GCA need to be
on your radar—and now they are.
Ruth Werner, BCTMB, is a former massage
therapist, a writer, and an NCBTMB-approved
provider of continuing education. She wrote A
Massage Therapist's Guide to Pathology (Lippincott
Williams & Wilkins, 2016), now in its sixth edition,
which is used in massage schools worldwide.
Werner is available at www.ruthwerner.com.
Resources
Cimmino, M. A. et al. "A Seasonal Pattern in the Onset of Polymyalgia Rheumatica." Annals of the Rheumatic Diseases 49 (1990): 521–3.
Clifford, A., and G. Hoffman. "Polymyalgia Rheumatica and Giant Cell Arteritis." The Cleveland Clinic Foundation. June 2014. Accessed
September 2017. www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/rheumatology/polymyalgia-rheumatica-and-giant-cell-
arteritis/.
"Giant Cell Arteritis." Johns Hopkins Vasculitis Center. Accessed September 2017. www.hopkinsvasculitis.org/types-vasculitis/giant-cell-arteritis/.
"How Many People Per Year are Diagnosed with Polymyalgia Rheumatica?" Zocdoc. Accessed September 2017. www.zocdoc.com/
answers/21939/how-many-people-per-year-are-diagnosed-with-polymyalgia-rheumatica.
"Polymyalgia Rheumatica." Vasculitis Foundation. Last updated September 2012. Accessed September 2017. www.vasculitisfoundation.org/
education/forms/polymyalgia-rheumatica/.
"Questions and Answers About Polymyalgia Rheumatica and Giant Cell Arteritis." National Institute of Arthritis and Musculoskeletal and Skin
Diseases (NIAMS). May 2016. Accessed September 2017. www.niams.nih.gov/Health_Info/Polymyalgia/default.asp.
Saad, E. "Polymyalgia Rheumatica." Medscape. Last updated September 19, 2016. Accessed September 2017. http://emedicine.medscape.com/
article/330815-overview#showall.
April 2017 edition of Pathology Perspectives
"Raynaud's Syndrome," page 40).
But in addition to these, GCA has some
potentially disabling complications. It can
lead to blindness if the nerves that supply
the eye are deprived of blood flow, and this
vision loss is permanent. Other obstructions
in cranial arteries might lead to mild or
severe stroke. And weakness in arterial walls
can cause the inner layers of the ascending
thoracic aorta to split: this is called a
dissecting aneurysm. This allows blood
between layers to accumulate and thicken,
and when fragments break loose, they can
cause ischemic damage wherever they land.
Increased mortality due to cardiovascular
events is a known consequence of GCA.
Differential Diagnoses
A few conditions can present similarly to
PMR or GCA, and they may only be found
when the typical treatments (low or high
doses of steroidal anti-inflammatories)
don't work well. Among the conditions
that may be revealed this way, we find
hypothyroidism, amyloidosis, rheumatoid
arthritis, and various types of cancer.
IMPLICATIONS FOR
MASSAGE THERAPY
PMR affects up to 1.6 million people in
the United States, and it rises in frequency
as people age. It usually presents like a
musculoskeletal problem—it could easily
be mistaken for signs of arthritis, muscle
fatigue, fibromyalgia, headache, or several
other common complaints for which people
seek massage. It is entirely likely that a
senior client may come to a trusted massage
therapist, complaining of new shoulder or
hip pain: "I must have really overdone it at
my job/in the garden/on the golf course/
playing with grandkids," and so on.
But this pain is unlikely to be addressed
successfully with massage therapy or
bodywork. Indeed, massage may make this
worse, and that is an important piece of
information. If the joint-related aches and
pains don't improve with massage, and if
they continue to worsen—especially if they
begin to include headaches, scalp pain,
jaw or tongue pain, or vision changes—it
is absolutely vital that the person see a
specialist as soon as possible. Any further
delay may lead to irreversible changes in
vision, and a substantial risk of stroke,
aneurysm, or other complications.
What if a person has already been
diagnosed and is currently treating their
condition? Clients who have been diagnosed
with either PMR or GCA are likely to take
