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36 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 7 education PATHOLOGY PERSPECTIVES Have you ever had any senior clients who came to you for help with shoulder pain, hip pain, or a headache? Have they ever been slow to respond to massage, or even become worse? Have you considered that their situation may be more complicated than it appears, and that without appropriate treatment, they may be at risk for blindness, stroke, or aneurysm? Polymyalgia rheumatica is among the most common types of inflammatory joint pain seen in older people. It is often accompanied by another condition, giant cell arteritis, which can lead to irreversible vision changes and worse. In this column, we'll take a look at these two fairly common, poorly understood, potentially dangerous, but highly treatable conditions that affect older adults. DEFINITIONS: WHAT ARE THEY? Polymyalgia rheumatica (PMR): it's a complicated name. Its etymology suggests that it means "multiple muscle pains and problems with flow of the humors," although modern usage applies the word rheumatism to nonspecific joint problems. And the leading symptoms of PMR do indeed look like muscle pain—although, as we will see, the problems begin elsewhere. Giant cell arteritis (GCA) refers to inflammation and abnormally large white blood cells found in the lining of affected medium and large arteries. It used to be called temporal arteritis because it was frequently found in the temporal artery, but tissue studies reveal it affects many other arteries as well. What is the link between PMR and GCA? These two conditions are autoimmune problems, and they often occur together. Statistics vary, but most specialists agree that 15–20 percent of all people who have PMR also develop GCA, and of those who have GCA, it appears that about 50 percent of them have also had PMR. Further, studies of people with PMR often reveal the same subtle tissue changes that are seen with GCA, but they are asymptomatic. These correlations have led some researchers to propose that the two conditions exist on a continuum, with PMR on the mild end and GCA on the more severe end. However, it is important to point out that a person can experience one without the other, and it is possible that a person can have symptoms of both conditions simultaneously, or in reverse order. WHO IS AT RISK? PMR and GCA have some extremely reliable demographic distributions. They are seen in Caucasians far more often than in other races, and their global incidence demonstrates a higher-than- Polymyalgia Rheumatica and Giant Cell Arteritis Common, Dangerous, Treatable By Ruth Werner Polymyalgia Rheumatica less severe more severe Giant Cell Arteritis ????? average concentration of cases in Northern Europe, especially Scandinavia. PMR and GCA are rare in people under 50. The average age at onset is about 72. Women develop these conditions about twice as frequently as men. It is difficult to pin down how many people in this country have PMR or GCA. Some estimates suggest they are diagnosed about 47,000 times each year, and about 1.6 million people currently live with one or both of these challenges. Three features make these conditions a topic that massage therapists should know about: • Early symptoms include shoulder and hip pain, and possible headaches— all of which may prompt affected people to seek massage. • Both PMR and GCA respond well to medical intervention, so individuals should pursue this quickly (and Specialists believe that polymyalgia rheumatica and giant cell arteritis are related, but the nature of their connection is not clear.

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