DEAR DR. DONOHUE: Please discuss polymyalgia rheumatica. My husband, age 71, was diagnosed with it. For two months, his muscle aches and pain were so bad that he could not get out of bed in the morning. It took four different doctors and three blood tests to find out what was wrong with him.

The doctor has him on the steroid prednisone, and he is doing much better. Why did it take so long to find this disease? — B.T.

ANSWER: Polymyalgia (POL-ee-my-AL-gee-uh) rheumatica (rue-MAT-ee-kuh) is a name unfamiliar to many, but it is truly a fairly common illness. It almost never happens to those younger than 50, and is most prevalent in those in their 70s. It usually comes on rapidly, with muscle and joint pain and stiffness. The hips and shoulders are the areas most often targeted. Raising the arms above the head is most difficult. Combing the hair presents a challenge.

On average, it takes a month to make the correct diagnosis. It’s often mistaken for some other ailment, like arthritis. That causes the delay in finding the actual cause.

Although muscle pain is the symptom most often complained of, the true trouble arises in inflammation of the joint lining. Muscles adjacent to the joint hurt. Most authorities believe this is another example of an autoimmune illness, one where the immune system turns on its own tissues.

No test specifically identifies polymyalgia as the cause of pain. However, the sedimentation (sed) rate is always high. It’s not a high-tech test. Blood is put into a calibrated tube, and the distance, in one hour, that blood drops from the top of the tube is the sed rate. C-reactive protein, another test of body inflammation, also is elevated.

Prednisone, one of the cortisone medicines, quickly controls symptoms. Usually a patient feels much better in a matter of days. Treatment, however, might need to continue for a year or more to prevent a relapse.

A companion illness is giant cell arteritis, also called temporal arteritis. Arteritis is inflammation of blood vessels. It has to be treated quickly to prevent blindness. Prednisone in higher doses is its treatment.

DEAR DR. DONOHUE: My son, age 63, developed a ping-pong-ball-size sac of fluid on his elbow. He has no pain. He was told it was bursitis. The fluid was drained, but came back immediately. He was told additional draining could lead to infection. He is on anti-inflammatory medicine. What can be done for it? — H.K.

ANSWER: Bursas are small, pancake-shaped devices that nature inserted between tendons and bones to reduce friction as the tendons rub against bone. Your son has olecranon bursitis, inflammation of the elbow bursa. The bursa swells with fluid. Elbow trauma is one cause. So is constantly supporting the head with the arms while the elbows rest on a desk. Quite often, a cause isn’t identified.

If the swelling isn’t painful, then resting the elbow — encircling it with a compression bandage or sleeve and letting time do its thing on the swollen bursa — takes care of the problem.

If the swelling is large or painful, it can be drained more than once. One of the cortisone drugs, instilled after fluid drainage, prevents the fluid from returning.

DEAR DR. DONOHUE: I have Raynaud’s disease in my hands, and have had it for 30 years. I now have neuropathy in my feet. Are they related? — S.B.

ANSWER: They’re not related. Raynaud’s is a sudden constriction of arteries to the hands and fingers when they are exposed to cold or when a person is under stress. The fingers turn white at first, then blue and then red as the constriction relaxes and fresh blood rushes to the fingers. Pain can be intense.

Neuropathy is a nerve disorder.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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