Polymyalgia rheumatica (PMR) is an uncomfortable condition that causes pain, stiffness, and inflammation in the muscles around the shoulders, neck, and hips.
The main symptom is morning muscle stiffness, which persists for at least 45 minutes. Other symptoms may also occur, including:
- Fever and sweating
- Loss of appetite
- Weight loss
The diagnosis of polymyalgia rheumatica requires a lot of attention. Due to the similarity of symptoms, cases where it is confused with rheumatoid arthritis are not rare.
The suspicion of polymyalgia rheumatica should arise only when pain and stiffness persist beyond a week.
Medicines and Diet
The treatment of rheumatic polymyalgia is of an anti-inflammatory and pain-relieving pharmacological type.
The most commonly used molecule is a corticosteroid called prednisolone, which is used to relieve symptoms; the dose is initially high and is reduced over 1,5-2 years.
Polymyalgia rheumatica may require one specific diet. The nutritional scheme is not aimed at the treatment of the triggering agent, but at the prevention of pharmacological side effects. Corticosteroids tend to increase the risk of osteoporosis.
For this reason, the diet for polymyalgia rheumatica must possess all the nutritional characteristics typical of the diet against osteoporosis.
OSTEOPOROSIS IN BRIEF
Osteoporosis refers to a loss of skeletal strength.
At the base of the osteoporotic condition there is a reduction in bone mass, architecture and strength. In practical terms, there is a demineralization and a loss of hydroxyapatite (calcium + phosphorus).
The causes are manifold; more often nutritional, metabolic, pharmacological, hormonal and pathological.
During cortisone therapy, it is necessary to correct some inappropriate factors or behaviors "at risk" for osteoporosis; particularly:
- Eliminate cigarette smoke
- Increase sun exposure
- In case of a sedentary lifestyle, promote physical activity; later we will see how.
Recall that the most important causal agent of osteoporosis is attributable to the lifestyle in developmental age (growth).
It consists in the failure to reach peak bone mass (due to nutritional deficiencies, sedentary lifestyle, drugs, etc.) and, in adulthood, it cannot be changed.
This means that the diet for polymyalgia rheumatica is an eating style that aims to reduce the chances of skeletal complications, but it is NOT a cure-all.
It is possible to try to prevent the onset or aggravation of osteoporosis by applying a series of dietary and lifestyle corrections.
It is always necessary to eliminate:
- Alcohol abuse
- Specific nutritional deficiencies.
The food strategy must ensure a satisfactory intake of calcium and vitamin D.
On the contrary, it is advisable to limit the intake of some nutrients. If in excess, these could be potentially harmful; in particular, the following are mainly involved:
- Excess sodium
- Excess of phosphorus
- The excess protein
- The excess of anti-nutritional agents.
Calcium and phosphorus are the elements that form hydroxyapatite.
It is assumed that nutritional deficiency or increased calcium excretion may promote the risk of osteoporosis.
The body absorbs these minerals from food; however, drug therapy of polymyalgia rheumatica impairs dietary calcium absorption.
The nutritional requirement for calcium is not always easy to meet with ordinary nutrition. This can increase in growth, pregnancy, lactation, old age and drug therapy with corticosteroids.
To counteract the side effect of drugs for polymyalgia rheumatica, people over the age of 60 (especially females) should increase their nutritional intake of calcium. In this case, it is advisable to achieve a daily intake of 1.000mg or more; better if between 1.200 and 1.500mg / day.
Typically, this goal can be achieved by drinking a liter of milk / yogurt a day and eating certain foods rich in calcium; among these, especially aged cheeses and fortified foods.
In the event that it is not possible to comply with these recommendations, it becomes necessary to rely on a nutrition professional for a personalized diet.
The diet for polymyalgia rheumatica must also be rich in vitamin D (calciferol), a pro-hormonal fat-soluble molecule.
This vitamin is crucial for the functioning of bone metabolism. Without calciferol, regardless of the availability of calcium and phosphorus in food, the body is unable to effectively prevent the rarefaction of the skeleton.
Ultimately, vitamin D is needed to absorb and metabolize dietary calcium.
Calciferol is produced independently by the body. This happens thanks to the exposure of the skin to the sun's rays.
Vitamin D can also be obtained from food. The foods richest in calciferol are oily fish and egg yolk.
In addition, the food industry offers a wide choice of diet products that are fortified with this vitamin. Most are dairy in nature or substitutes, such as: milk, soy milk, yogurt, soy yogurt etc.
To have a good nutritional intake of calciferol it is necessary:
- Eat 3 servings of oily fish per week (150-250g). The portion and frequency of consumption cannot be unlimited or excessively abundant. Keep in mind that fishery products, especially large ones, can contain moderate levels of mercury (toxic polluting metal).
- Consume 3 whole eggs per week
- Consume some fortified products daily.
Especially in subjects over 60 years of age, it is advisable to take a food supplement with a dosage of 10-20μg or 400-800 international units (IU) of vitamin D daily.
The motor therapy of polymyalgia rheumatica requires an accurate knowledge of the subjective needs and physical characteristics. It is strictly necessary to find the right balance between physical exercise (volume, intensity, frequency, etc.) and rest / recovery.
Usually, motor activity helps relieve morning stiffness and moderate the overall symptoms of polymyalgia rheumatica. Nevertheless, if in excess, it is able to aggravate the perception of pain.
Physiotherapy can be helpful in fighting pain and maintaining joint mobility.
Protocols that allow mechanical stress to be applied to the skeleton help maintain bone density and architecture.
The most tolerated activity on average is walking, slow or fast, on the plains or with gradients. The most daring or those who deal with pain better, try their hand at alternative activities such as: running, other aerobic sports (swimming, cycling, etc.), exercises with rubber bands (overloads), etc.
Potentially Harmful Molecules
There are dietary components which, by interfering with the absorption and metabolism of calcium and vitamin D, are capable of compromising bone health.
The diet for polymyalgia rheumatica must take this into account and try to prevent such interactions.
At certain concentrations, calcium and phosphorus can conflict in intestinal absorption. The right ratio between the two ions is 3: 1 or 2: 1.
- Calcium is generally more deficient in foods than phosphorus
- An excess of phosphorus can worsen the intestinal absorption of calcium
it is advisable not to exceed with products very rich in phosphorus, preferring those abundant in calcium (especially in the same meal).
For example, it is better to avoid associating certain seeds (pumpkin, sunflower, quinoa, etc.) with milk, aged cheeses and fortified foods. Remember that phosphorus is still abundant even in dairy foods.
Excess dietary sodium is a potentially harmful factor for calcium metabolism.
It is assumed that excess sodium in food can promote urinary excretion of calcium by increasing its metabolic demand.
Other sources suggest a similar effect attributable to excess protein and nitrogen. On the other hand, in this case scientific research does not offer repeatable results.
The presence of anti-nutritional molecules is able to bind (chelate) calcium in the intestinal lumen, preventing its absorption. This happens above all in the presence of oxalic acid which, by binding to calcium, gives rise to calcium oxalate. Oxalic acid is mainly contained: in rhubarb, spinach, beets, cocoa, beetroot, etc. Although the concentration in foods can be reduced with cooking, it is advisable to avoid combining foods with oxalic acid with those rich in calcium.
Another molecule that exerts a similar effect is phytic acid, typical of legumes and cereal bran. Phytic acid has a chelating effect, which mainly affects zinc and iron, but it is also advisable to avoid it to optimize calcium absorption. It degrades with cooking and can be partially eliminated by soaking legumes or bran (discarding the water).
To optimize calcium absorption it is also advisable to avoid the onset of diarrhea. This can have many triggers; it is recommended to pay attention to:
- Foods responsible for the typical symptoms of food intolerances (lactose or gluten)
- Laxatives: foods, drugs and supplements
- Excess of fiber: foods and supplements
- Excess of nerves: especially stimulating drinks (coffee, fermented teas, chocolate and energy drinks) and thermogenic food supplements.
In the symptomatological reduction of rheumatic polymyalgia, small precautions can also be helpful, such as:
- Regularly practice stretching and exercises to improve joint mobility
- Practice thermal baths.
Causes, Incidence and Complications
The causes of polymyalgia rheumatica are currently unknown; the most accepted hypothesis is a combination of genetic and environmental factors.
Polymyalgia rheumatica is a fairly common disorder. In subjects over 50 years old (most are> 70 years old), an incidence of 10 cases per 100.000 inhabitants is estimated. On the other hand, it is very rare in young people. It mainly affects females.
Polymyalgia rheumatica has a very important statistical correlation with temporal Horton's (giant cell) arteritis.
The symptoms of the latter pathology, which can occur before, during or after polymyalgia rheumatica, are:
- Headache and swelling of the scalp (painful to touch)
- Pain in the jaw muscles when chewing
- Visual disturbances (double vision or functional reduction).
Unlike polymyalgia rheumatica, arteritis requires sudden medical attention to avoid permanent damage.
Also in this case the therapy is mainly pharmacological based on corticosteroids.