STORY BYFor more than a year, Mary Margaret Carmichael lived with aches and pains that were so severe she was scared to lift her granddaughter to give her a hug.
She went to numerous specialists, none of whom were able to diagnose the cause of her persistent low-grade fever and stiffness and pain in her neck, shoulders, back and hips.
It was very frustrating," says Carmichael, now 63. "I couldn't turn my neck. If I was driving, I'd have to turn my whole body to see if traffic was coming. I thought I was going to have to live with this pain for the rest of my life."
A rheumatologist at The University of Texas Medical School at Houston finally determined that Carmichael had polymyalgia rheumatica, a form of arthritis that is relatively simple to treat but often difficult to diagnose.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, an estimated 700 out of 100,000 people older than 50 develop polymyalgia rheumatica, a disorder that literally means pain in many muscles.
"There is a misconception that these aches and pains are part of the aging process, but these aren't your average aches," says Carmichael's physician, Dr. Frank Arnett, professor of internal medicine.
"Polymyalgia rheumatica can be devastating," he said. "Patients are in pain. If they can get any sleep, when they wake up, they are so sore they don't want to get out of bed. It's a systemic illness. They lose weight. They become depressed."
Women are twice as likely as men to develop the arthritic condition, and while the cause of polymyalgia rheumatica is not known, it appears that genetic and environmental factors play important roles in the disease.
Stiffness is the main symptom, and in many cases, it begins suddenly in otherwise healthy people. It usually manifests in the neck, shoulder and hip joints, but also can affect the hand and knee joints.
Oftentimes, patients have symptoms for at least a year before they are accurately diagnosed, Arnett says. This is because the disease can mimic other disorders, including rheumatoid arthritis.
The good news, Arnett says, is that the disease is "so treatable and inexpensive to do so." A simple blood test called the erythrocyte sedimentation rate measures inflammation in the body and can be used to confirm the diagnosis.
"If the test reveals an abnormality, we give them a trial of a low-dose steroid," Arnett says. "Usually, within 24 to 48 hours, their symptoms are gone."
The medication works to reduce pain, inflammation, stiffness, fatigue and fever. Regular exercise may also help maintain joint flexibility, muscle strength and function.
Carmichael said she was reluctant to try the prescribed therapy because she was worried about the side effects of taking a steroid. "I didn't want the puffiness or the weight gain, but I didn't want the pain either."
Arnett says the dose is so low that most people don't experience significant side effects. Patients start with 15 milligrams of prednisone, and gradually the dosage is cut back to between 2.5 to 5 milligrams. Eventually, they may be able to discontinue the medication altogether.
"I noticed a difference immediately," Carmichael recalls. "I got all of the benefit and none of the side effects. I'm now down to 7.5 milligrams, and I have not had any pain."
Arnett says it is important for patients who are experiencing stiffness and muscle pain in their neck, shoulders or hips to see a rheumatologist.
If polymyalgia rheumatica is left untreated, it could develop into giant cell arteritis, a disorder that results in inflammation of arteries in the head and neck, which could lead to sudden blindness or stroke.
"People don't have to live with the pain," Arnett says. "It is so easily treatable."
UPDATED: 9-16-2004
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Dr. Frank Arnett is professor of internal medicine and the Elizabeth Bidgood Chair in Rheumatology at the UT Medical School.
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Tetanus booster for adults
Tetanus does not result from the rusty nail or whatever created the wound. The danger lies in the bacteria Clostridium tetani that lives in the soil or manure on that nail or gardening tool. When these spores get into a wound—deep or shallow—they can produce a potent toxin. Also called lockjaw, tetanus seriously affects the central nervous system and can be fatal.
Onset of symptoms can occur anytime from three days to three weeks. Call your health care provider if you have an open wound, particularly if:
Adults should have a tetanus booster shot every 10 years, known as the Td vaccine. It is a "2-in-1" vaccine that protects against tetanus and diphtheria. It contains a slightly different dose of diphtheria vaccine than what you received as a child. It can be given to anyone older than 7 years and is injected, usually into the arm.
Instead of the standard Td booster every 10 years, adults between the ages of 19 and 65 should receive Tdap one time in their adulthood to boost the immune system for pertussis, as well as tetanus and diphtheria.
Diphtheria, a contagious bacterial infection created that causes severe inflammation of the throat and larynx and can also affect the whole body. Pertussis or “whooping cough” is a serious bacterial infection that afflicted children and infants before vaccines were available. Adults may be infected later in life as their immunities wane. Neither of these infections are related to tetanus, but both vaccines are compatible and convenient to use with the tetanus booster.
