Polymyalgia Rheumatica? Avoid or minimise steroid drugs with natural approaches
with Belle McCALEB
Polymyalgia rheumatica (PMR) is a relatively common condition characterised by aching joints and morning stiffness particularly affecting the shoulders and hips but also can affect the neck, upper arms, lower back and thighs. Usually the pain is symmetrical but asymmetrical arthritis of the knees, hands and feet can occur. There is usually no detectable swelling of the affected joints. It is twice as common in women and the incidence increases over the age of 50. Other signs that may be associated are a low grade fever, weight loss, anorexia, anxiety and depression and these occur in up to 40% of cases.1
Medical diagnosis of PMR is based on symptoms and elevation of inflammatory markers in the blood. Other illnesses that can mimic PMR should be ruled out including cancers of the blood and bone marrow, hypothyroidism, statin drug induced muscle pain, and other rheumatic diseases. PMR is associated with a condition called Giant Cell Arteritis that requires emergency intervention in order to prevent damage that may lead to blindness.
The cause of PMR is unclear but genetic predisposition is suspected as is a viral link since the condition often has a seasonal variation. There is evidence that the disease is immune mediated (eg an auto immune condition).2
Medical treatment of PMR is with steroid drugs to suppress the inflammation. These drugs are not without risks in the long term including osteoporosis, hypertension, diabetes, cardiac failure, glaucoma and decreased immunity. Therefore it is worth trying alternative natural anti-inflammatory approaches. In addition, natural medicines are available which act as anti-virals and immune modulators. These might address suspected underlying causes.
Herbal anti-inflammatories include Curcumin from Turmeric, Boswellia, Devil’s Claw, White Willow, Hops and Rosemary, Omega 3 fatty acids from fish or krill oils are also strong anti-inflammatories. Anti-viral herbs include Andrographis, Echinacea, Elder Flower, and Olive Leaf. Nutritional anti-viral approaches include high doses of buffered Vitamin C and zinc. Immune modulation or treatment of auto-immunity can be done with herbs such as Polypodium leucotomas and Ganoderma lucidum. In addition it is important to check Vitamin D blood levels as low vitamin D is strongly associated with auto-immunity. Ideally the Vitamin D level should be over 100 if not 125. The current “acceptable” range for Vitamin D starts at 50 according to many laboratories. This might be reflecting the “normal range” eg average in our population but it is not the optimal range.
In addition to herbs and Vitamin D supplementation for autoimmunity it is vital that the gut and liver health is optimised. We know that immunity is regulated to a great extent from these two areas by cells called T regulatory cells. A gentle gut and liver detox program involving specific probiotics, prebiotics and herbal remedies helps to restore the microflora (good bugs), decrease inflammation and modulate the immunity. We also know that viral loads are often carried in the liver thus supporting this organ, particularly with herbal medicines such as St Mary’s Thistle extract, curcumin and Andrographis is essential.
Diet, exercise and lifestyle choices are extremely important in PMR. Eating a “low stress” diet that decreases inflammatory responses is essential. I generally recommend eliminating red meat, gluten, sugar and all processed foods as well as decreasing omega 6 fats (from grains such as Safflower). Alkalinising the body with loads of fresh vegetables, particularly the green leafies either in salads, stir-frys, green juices or green smoothies is helpful. Identifying food intolerances may be indicated and this can be done with the IGG blood testing through a laboratory. Gentle exercise such as a gentle form of Hatha Yoga or Tai Chi is beneficial as is regular walking and stretching. Very gentle massage and other body therapeutics may help. The Ayurvedic hot oil massage may be particularly beneficial. Finally, working on stress is very important as stress increases the pain response. Specifically look to gentle yoga and meditation as this has been shown to decrease pain perception in many painful conditions. We also have a wide range of herbal medicines that can support the adrenals, the glands that make our stress coping hormones.
1van Hecke O, Polymyalgia rheumatica, diagnosis and management, Australian Family Physician, Vol 40, no 5, May 2011, 303-306
2 Cimmino M, Genetic and environmental factors in polymyalgia rheumatica, Ann Rheum Dis 1997;56:576-577 doi:10.1136/ard.56.10.576
For women’s health go to www.mccalebhealth.com.au. Belle McCaleb ND, RN, MSS-C, BSN, RYT has been a registered health professional since 1986. She is a naturopath, herbalist, Master’s prepared counselor, Registered Nurse and Registered Yoga Teacher. Belle firmly believes total health and wellness are only achievable through the integration of body, mind and spirit. She specializes in women’s health and cancer support and holds advanced nursing qualifications in obstetrics, gynaecology and reproductive endocrinology and infertility. Belle has specialised in cancer support since 2003, is the founder of the Cancer Support Alliance (www.cancersupportalliance.com.au) and was the Consultant Naturopath for Cancer Care Centre for seven years.” She has a particular interest in keeping cancer patients well during their chemotherapy and radiotherapy treatments, combining knowledge from her extensive nursing background with natural medicine and dietary approaches. Belle teaches gentle yoga classes at her private studio, Serenity Yoga and also offers individual therapeutic yoga sessions for particular health issues. She is currently undertaking a Postgraduate Diploma in Yoga Therapy. Belle is located in St Georges (Burnside), SA. For more info see www.mccalebhealth.com.au.