This is a little known but relatively common condition that causes pain and stiffness around the neck and shoulders and in the hips and thighs (usually described by medics as shoulder and hip girdle pain).
The cause is unknown, though both genetic and environmental factors seem to be involved.
It is thought to be caused by inflammation in the synovium —the membrane that surrounds the inside of the joint.
There is no definitive test for the condition, so the diagnosis is based on recognising a combination of symptoms.
Patients are universally over the age of 50 and most usually female — three women are affected for every one man — though we do not know why.
The most common symptom is pain in both shoulders but progressing to the hip joint region. Typically, sufferers experience at least half an hour of aching and stiffness in the mornings, which becomes more severe as the condition progresses. A blood test will also show inflammation.
A complication in diagnosing the condition is that it is very similar to giant cell arteritis, in which the walls of many arteries throughout the body become inflamed. This is potentially damaging if not diagnosed and treated promptly.
Polymyalgia is the more common of the two, although about 20 per cent of patients do eventually develop giant cell arteritis, with its added symptoms including headaches (tenderness in the temples), jaw pain, fever, weight loss and sometimes visual disturbance.
If you develop new headaches and any of the symptoms, see a doctor without delay.
You tell me in your longer letter that you were prescribed steroids, which can reduce inflammation, but you say that the side-effects were intolerable.
In polymyalgia rheumatica, the response to a fairly small starting dose of the steroid tablet prednisolone is usually rapid and remarkable — 12.5mg or 15mg each day will abolish the symptoms in less than a week. Subsequently the dose can be gradually reduced over one to two years.
CONTACT DR SCURRTo contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details.Dr Scurr cannot enter into personal correspondence.His replies cannot apply to individual cases and should be taken in a general context.
At these small doses, for most people the side-effects of weight gain, indigestion, sleep disturbance and elevated blood pressure are not usually too intolerable compared to the relief.
A considerable difficulty is when the picture is not typical, and your letter describes constant pain in your legs, not just morning pain, and no mention of the neck and shoulder region. (It may be that you sense your doctor is not too sure of the diagnosis because the exact picture is not yet clear.)
Other possible diagnoses include other rheumatic disorders such as early seronegative rheumatoid arthritis (seronegative meaning that the specific tests for rheumatoid arthritis are negative, but the condition looks typical), fibromyalgia and even osteoarthritis of the spine with referred pain to the legs. Your story is far from typical for polymyalgia rheumatica, and my advice would be to encourage a frank discussion with your GP to ask for a re-evaluation and perhaps even the diagnostic opinion of a rheumatologist.
For the past few months I’ve noticed there is blood in my semen. My friends say this is normal, but I’m concerned. I am a 70-year-old bachelor but am reluctant to speak to my GP as she is female. Name and address supplied.How very alarming and upsetting for you.
This is not a common condition, and may baffle many doctors. I see only one or two patients each year with this, and I have never seen a case that had a sinister cause. Yet when patients see unexpected bleeding from almost any site, cancer is often the first thought in their minds.
The traditional teaching has always been that haematospermia — the correct technical description for your condition — is most often due to seminal vesiculitis: infection in the seminal vesicles, the small storage tanks for seminal fluid which are situated alongside the prostate.
Each vesicle is about the size of an almond, and if there is infection, it is usually due to bacteria which have arrived there from another part of the body, most commonly the intestine (although it can also have been sexually transmitted).
There is always a small worry in older patients — men over the age of 50 — that prostate cancer can cause the type of bleeding that you experience.
Other causes of bleeding include prostate biopsy or even vasectomy, although these do not apply in your case.
The best way to investigate the symptom is to send a sample to the laboratory for investigation and to undergo a prostate examination both by digital rectal examination and also by ultrasound scan.
Laboratory tests may reveal the identity of an infecting organism, and then an appropriate antibiotic can be prescribed.
Most frequently these tests show red blood cells and white cells (pus), but do not discover any organisms — and then there is a dilemma.
More from Martin Scurr... How can I get this heavy feeling off my chest? 03/06/13 Ask the doctor: Bad breath is ruining my self-confidence 27/05/13 Ask the doctor: Will my shingles pain ever go away? 20/05/13 Ask the doctor: Is blood in my urine a reason to worry? 13/05/13 Ask the doctor: Why am I seeing stars in my eyes? 07/05/13 Ask the doctor: Why are my teeth starting to crumble? 22/04/13 Ask the doctor: Simple steps for easing a hormone headache 08/04/13 Ask the doctor: Why do my wife's hands bruise so easily? 01/04/13 VIEW FULL ARCHIVEAlthough the condition is benign and will resolve itself, some doctors will prescribe a broad spectrum antibiotic such as doxycycline or ciprofloxacin that targets a wide range of bugs. This will be a fairly long course, i.e., at least two weeks.
I suggest you overcome your natural reluctance to speak to a female GP and ask her about a referral to a specialist in urology.
By the way...Botox should only be done by prosWhen I started as a GP, there were just 75 plastic surgeons in the UK, compared with more than 1,500 in Los Angeles alone. But thanks to celebrity culture and the increasing emphasis on looks, the picture has rapidly changed — no longer the preserve of health and medicine, cosmetic enhancement is now little more than a branch of hairdressing. Cosmetic procedures such as Botox need tougher regulation, a UK review has said Many of my patients — and even a few of my medical colleagues — have availed themselves of botulinum toxin injections (Botox) or dermal fillers to attempt to improve the appearance of wrinkly faces. Most of those patients would not dream of telling me that they do this regularly (it’s never a long-lasting procedure and must be repeated). No doubt that’s because they’re reluctant to let their vanity surface in serious medical consultation, and perhaps fear. So I usually become involved only when things go wrong (infections are not uncommon).Actually, I am more sympathetic than most realise, and it is far better I am involved so that patients can be referred to professional experts who are properly regulated by the appropriate bodies.The worry is that too many are instead drawn to cheap-and-cheerful treatments. This has led to a huge growth in unqualified pseudo-experts, from beauticians to hairdressers, and the uncontrolled use of such techniques. The government even aided and abetted this tsunami by de-regulating the use of medical lasers.Now, at last, this industry is due to be regulated, following the publication last week of a major review. I think it’s a bit weedy: the suggestion is that everyone carries on as before, but they must be trained — yet there is no formal mechanism to provide this training.In my view some procedures should never be carried out by non-medical practitioners, including botulinum toxin injections, dermal fillers and chemical peels. Possibly, these procedures could be carried out by nurses under the supervision of doctors who prescribe the treatment.But last week’s review is a start. The medical profession, and especially the British Association of Aesthetic Plastic Surgeons, has waited a long time for this. It is not about forming a closed shop, a protective cartel; it is about the safety and care of the general public.
