Parkinson’s disease
of brain nerves and spinal cord

Parkinson’s disease is a condition in which parts of the brain become progressively damaged over many years.

The three main symptoms of Parkinson’s disease are:

involuntary shaking of particular parts of the body (tremor) slow movement stiff and inflexible muscles

A person with Parkinson’s disease can also experience a wide range of other physical and psychological symptoms, including:

depression and anxiety balance problems – this may increase the chance of a fall loss of sense of smell anosmis problems sleeping (insomnia) memory problems

Read more about the symptoms of Parkinson’s disease

Symptoms

The symptoms of Parkinson’s disease usually develop gradually and are mild at first.

There are many different symptoms associated with Parkinson’s disease. Some of the more common symptoms are described below.

However, the order in which these develop and their severity is different for each individual. It’s unlikely that a person with Parkinson’s disease would experience all or most of these.


The three main symptoms of Parkinson’s disease affect physical movement:

tremor – shaking, which usually begins in the hand or arm and is more likely to occur when the limb is relaxed and resting slowness of movement (bradykinesia) – where physical movements are much slower than normal, which can make everyday tasks difficult and can result in a distinctive slow, shuffling walk with very small steps muscle stiffness (rigidity) – stiffness and tension in the muscles, which can make it difficult to move around and make facial expressions, and can result in painful muscle cramps (dystonia)

These main symptoms are sometimes referred to by doctors as parkinsonism as there can be causes other than Parkinson’s disease.


Parkinson’s disease can also cause a range of other physical and mental symptoms.


balance problems – these can make someone with the condition more likely to have a fall and injure themselves loss of sense of smell (anosmia) – sometimes occurs several years before other symptoms develop nerve pain – can cause unpleasant sensations, such as burning, coldness or numbness problems with urination – such as having to get up frequently during the night to urinate or unintentionally passing urine (urinary incontinence) constipation an inability to obtain or sustain an erection (erectile dysfunction) in men  difficulty becoming sexually aroused and achieving an orgasm (sexual dysfunction) in women dizziness, blurred vision or fainting when moving from a sitting or lying position to a standing one – caused by a sudden drop in blood pressure excessive sweating (hyperhidrosis) swallowing difficulties (dysphagia) – this can lead to malnutrition and dehydration excessive production of saliva (drooling) problems sleeping (insomnia) – this can result in excessive sleepiness during the day


depression and anxiety mild cognitive impairment – slight memory problems and problems with activities that require planning and organisation dementia – a group of symptoms, including more severe memory problems, personality changes, seeing things that aren’t there (visual hallucinations) and believing things that aren’t true (delusions)


As well as the main symptoms of movement problems, people with Parkinson’s disease can experience a wide range of additional symptoms that may need to be treated separately.

These include:

depression and anxiety – this can be treated with self care measures such as exercise, psychological therapy or medication; read more about treating depression problems sleeping (insomnia) – this can be improved by making changes to your normal bedtime routine; read more about treating insomnia erectile dysfunction – this can be treated with medication; read more about treating erectile dysfunction excessive sweating (hyperhidrosis) – this can be reduced using a prescription antiperspirant, or surgery in severe cases; read more about treating hyperhidrosis swallowing difficulties (dysphagia) – this can be improved by eating softened food, or by using a feeding tube in more severe cases; read more about treating dysphagia excessive drooling – this can be improved with swallowing exercises, or surgery or medication in severe cases urinary incontinence – this can be treated with exercises to strengthen the pelvic floor muscles, medication, or surgery in severe cases; read more about treating urinary incontinence dementia – this can be treated with cognitive therapies and medication in some cases; read more about treating dementia

Causes

Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.

Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson’s disease.

Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.

Read more about the causes of Parkinson’s disease


Parkinson’s disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra.

Nerve cells in this part of the brain are responsible for producing a chemical called dopamine. Dopamine acts as a messenger between the parts of the brain and nervous system that help control and co-ordinate body movements.

If these nerve cells die or become damaged, the amount of dopamine in the brain is reduced. This means the part of the brain controlling movement can’t work as well as normal, causing movements to become slow and abnormal.

The loss of nerve cells is a slow process. The symptoms of Parkinson’s disease usually only start to develop when around 80% of the nerve cells in the substantia nigra have been lost.


It’s not known why the loss of nerve cells associated with Parkinson’s disease occurs, although research is ongoing to identify potential causes.

Currently, it’s believed a combination of genetic changes and environmental factors may be responsible for the condition.

Genetics

A number of genetic factors have been shown to increase a person’s risk of developing Parkinson’s disease, although exactly how these make some people more susceptible to the condition is unclear.

Parkinson’s disease can run in families as a result of faulty genes being passed to a child by their parents. However, it’s rare for the disease to be inherited this way.

Environmental factors

Some researchers also feel environmental factors may increase a person’s risk of developing Parkinson’s disease.

It’s been suggested that pesticides and herbicides used in farming and traffic or industrial pollution may contribute to the condition.

However, the evidence linking environmental factors to Parkinson’s disease is inconclusive.


“Parkinsonism” is the umbrella term used to describe the symptoms of tremors, muscle rigidity and slowness of movement.

Parkinson’s disease is the most common type of parkinsonism, but there are also some rarer types where a specific cause can be identified.

These include parkinsonism caused by:

medication (drug-induced parkinsonism) – where symptoms develop after taking certain medications, such as some types of antipsychotic medication, and usually improve once the medication is stopped other progressive brain conditions – such as progressive supranuclear palsy, multiple systems atrophy, and corticobasal degeneration cerebrovascular disease – where a series of small strokes cause several parts of the brain to die

You can read more about parkinsonism on the Parkinson’s UK website.

Diagnoses

No tests can conclusively show that you have Parkinson’s disease. Your doctor will base a diagnosis on your symptoms, medical history and a detailed physical examination.

Your GP will talk to you about the problems you’re experiencing and may ask you to perform some simple mental or physical tasks, such as moving or walking around, to help with the diagnosis.

In the early stages, your GP may find it difficult to say whether you definitely have the condition because symptoms are usually mild.


Being told you have Parkinson’s disease can be emotionally distressing, and the news can often be difficult to take in.

This means it’s important that you have the support of your family and a care team who will be able to help you come to terms with the diagnosis.

You may find it useful to contact Parkinson’s UK, the Parkinson’s support and research charity.

They can be contacted by:

free helpline on 0808 800 0303 (Monday to Friday, 9am to 7pm, and 10am to 2pm on Saturdays) email: hello@parkinsons.org.uk

Parkinson’s UK brings people with Parkinson’s, their carers and families together through a network of local groups, as well as online resources and a confidential helpline.

The Parkinson’s UK website provides information and support on every aspect of living with Parkinson’s.

Treatments

Although there’s currently no cure for Parkinson’s disease, treatments are available to help reduce the main symptoms and maintain quality of life for as long as possible.

These include:

supportive treatments – such as physiotherapy and occupational therapy medication in some cases, brain surgery

You may not need any treatment during the early stages of Parkinson’s disease, as symptoms are usually mild. However, you may need regular appointments with your specialist so your condition can be monitored.

Read more about treating Parkinson’s disease


See your GP if you’re concerned you may have symptoms of Parkinson’s disease.

Your GP will ask about your symptoms and your medical history to help them decide whether it’s necessary to refer you to a specialist for further tests.

Read more about diagnosing Parkinson’s disease


There are several therapies that can make living with Parkinson’s disease easier and help you deal with your symptoms on a day-to-day basis.

There are efforts underway to try to increase the availability of these supportive therapies for Parkinson’s patients on the NHS.

Your local authority may be able to advise and help you. Ask your local authority for a care and support needs assessment.


As well as the main symptoms of movement problems, people with Parkinson’s disease can experience a wide range of additional symptoms that may need to be treated separately.

These include:

depression and anxiety – this can be treated with self care measures such as exercise, psychological therapy or medication; read more about treating depression problems sleeping (insomnia) – this can be improved by making changes to your normal bedtime routine; read more about treating insomnia erectile dysfunction – this can be treated with medication; read more about treating erectile dysfunction excessive sweating (hyperhidrosis) – this can be reduced using a prescription antiperspirant, or surgery in severe cases; read more about treating hyperhidrosis swallowing difficulties (dysphagia) – this can be improved by eating softened food, or by using a feeding tube in more severe cases; read more about treating dysphagia excessive drooling – this can be improved with swallowing exercises, or surgery or medication in severe cases urinary incontinence – this can be treated with exercises to strengthen the pelvic floor muscles, medication, or surgery in severe cases; read more about treating urinary incontinence dementia – this can be treated with cognitive therapies and medication in some cases; read more about treating dementia

Patau’s syndrome
of chromosomal conditions

In the UK, around 2 in every 10,000 births are affected by Patau’s syndrome.



Humans normally have 23 pairs of chromosomes. In each pair, 1 of the chromosomes is inherited from the mother and 1 is inherited from the father.

If a baby has Patau’s syndrome, they have inherited an extra copy of chromosome 13. This extra copy can be present in some or all of the baby’s cells and can lead to health problems for the baby.

There are 3 different forms of Patau’s syndrome:

Full form In full form Patau’s syndrome, the baby has inherited a complete extra copy of chromosome 13. This extra copy is present in all of the baby’s cells. Around 80% of babies born with Patau’s syndrome have the full form of the syndrome.

Mosaic form In mosaic form Patau’s syndrome, the baby has inherited a complete extra copy of chromosome 13, but the copy is only present in some of the baby’s cells.

Partial form In partial form Patau’s syndrome, the baby has only inherited part of an extra copy of chromosome 13. This is a very rare form of Patau’s syndrome.

Causes

Most cases result from a random change in the egg or sperm in healthy parents. This change is not caused by anything the parents did before or during pregnancy.

Pelvic inflammatory disease
of sexual and reproductive

Many different types of bacteria can cause PID. However most cases are the result of a chlamydia or gonorrhoea infection.

In some cases, the cause of the infection that leads to PID is unknown. Such cases may be the result of normally harmless bacteria found in the vagina. These bacteria can sometimes get past the cervix and into the reproductive organs.


In some cases, the cause of the infection that leads to PID is unknown. Such cases may be the result of normally harmless bacteria found in the vagina. These bacteria can sometimes get past the cervix and into the reproductive organs.

Symptoms

The symptoms of PID are fairly general, which means it can be difficult to diagnose. The symptoms may include:

pain around the pelvis or lower abdomen discomfort or pain during sex that is felt deep inside the pelvis bleeding between periods or after sex unusual vaginal discharge fever and vomiting pain in the rectum (back passage)

If diagnosed and treated early, the complications of PID can be prevented.

If treatment is delayed some of the complications are:

pelvic abscess formation long term or recurrent pelvic pain reduced fertility or infertility – this affects 1 in 10 women with PID and is more likely in severe infection or repeated episodes ectopic pregnancy – a serious condition where the baby grows outside the womb, most commonly the fallopian tube

Diagnoses

If you think you have PID you can make an appointment with your GP or local sexual health services.

There is no single test for diagnosing PID. Your doctor will diagnose PID based on your symptoms and an examination, as well as tests.

When your doctor examines you, they’ll look for tenderness in your pelvic region and an abnormal vaginal discharge. This will usually involve a gentle internal examination by the doctor or nurse. 

The doctor will usually take swabs from inside your vagina and cervix. The swabs will be sent to a lab to try to identify the type of bacteria causing the infection. However, a swab test can’t be relied on to diagnose PID, as some women with PID have a negative swab result.

You may have an ultrasound scan. Scans can identify severe PID but will not show up mild disease. It’s possible to have a normal scan and still have PID.

Treatments

If it’s diagnosed at an early stage, PID can be treated quickly and efficiently with antibiotics. You will probably be given antibiotics to take by mouth for at least 2 weeks.

Severe cases may be admitted to hospital for observation and treatment with antibiotic injections.

Always see your doctor or nurse if you think you might have PID, as the sooner you are treated, the better. If you’re given treatment, always make sure that you take all of your antibiotics and finish the entire course.

It’s advised that your partner(s) are treated and that you avoid sex until your treatment is completed.

Pelvic organ prolapse
of sexual and reproductive

Pelvic organ prolapse isn’t life-threatening. In some cases it can cause little or no problems. However, in more severe cases, it may feel very uncomfortable. It might stop you doing the things that you enjoy, and affect your quality of life. Like incontinence, prolapse isn’t inevitable part of ageing.

Speak to your doctor if you think you might have a prolapse. You don’t need to suffer or feel embarrassed. Many women can experience prolapse, but it can be treated.


Speak to your doctor if you think you might have a prolapse. You don’t need to suffer or feel embarrassed. Many women can experience prolapse, but it can be treated.

Symptoms

Some women with a pelvic organ prolapse don’t have any symptoms at all. The condition may only discovered during an internal examination for another reason. For example, during a cervical screening test (smear test). Other women will experience symptoms. It’s normal for your symptoms to feel more or less severe at different times of the day.

Speak to your doctor if: You think you might have a prolapse or you have symptoms of a prolapse such as: a feeling of a bulge or something coming down the vagina a feeling of a bulge or something coming out the vagina, which sometimes needs pushed back up (you may be able to see this with a mirror) discomfort during sex problems peeing – a slow stream, a feeling of not emptying your bladder fully, needing to go to the toilet a lot or leaking

Causes

There isn’t usually one cause, but the risk of developing pelvic organ prolapse is increased by:

age – prolapse is more common as you get older, but it’s not an inevitable part of ageing childbirth – particularly if you had a long or difficult labour, or have given birth to a large baby or multiple babies menopause – related to lower levels of oestrogen or weaker tissue being overweight having large fibroids or pelvic cysts which create a lot of pressure in the pelvis previous surgery on the pelvis – such as a hysterectomy repeated heavy lifting or manual work long term coughing or sneezing (caused by smoking, a lung condition or allergies) straining too much when going to the toilet for a poo because of long term constipation

Diagnoses

A prolapse is a common condition. Seeing your doctor earlier may help you manage it more easily.

Your doctor will need to carry out a pelvic examination, which will include an internal examination of your vagina. Your doctor will discuss this with you and you can ask any questions that you might have.

As this is an intimate examination, the doctor may have another person (chaperone) present. You can ask for a female doctor or health professional if you prefer.

The internal examination is similar to a smear test and should only take a few minutes. Your doctor will discuss with you if they think any further tests are needed.

Treatments

Treatment will depend on how much the issue is affecting your normal day to day activities.

In mild cases of prolapse, your doctor may recommend lifestyle changes. For example, regular pelvic floor exercises and maintaining a healthy weight.

Vaginal pessary

A vaginal pessary is a device inserted into your vagina, which holds your vaginal walls in place and so pushes the prolapse back. Pessaries are usually made of latex (rubber) or silicone, and come in different shapes and sizes.

A pessary might not be right for everyone. Your doctor will discuss with you to find out if it’s the best option, and you can ask any questions you may have. Some side effects can include:

vaginal discharge irritation, bleeding or sores inside your vagina stress incontinence difficulty with bowel movements difficulty having sex (although most women can have sex without problems) an imbalance of the usual bacteria found in your vagina

If you have a pessary and experience any of these symptoms, speak to your healthcare professional. They can usually be treated.

Hormone Replacement Therapy (HRT)

HRT replaces the female hormones that are at a lower level as you experience the menopause.

There is little evidence that HRT can directly treat pelvic organ prolapse, but it can relieve some of the symptoms associated with it. For example, vaginal dryness or discomfort during sex. Depending on your symptoms, you may wish to ask your doctor for more advice on whether this would be a suitable treatment option for you.

Surgery

Depending on your circumstances and how severe your symptoms are, your doctor may discuss with you whether a surgery might be helpful. They will go through the options with you.

It’s ok to ask any questions about your care to help you get the information you might need. You can then take some time to decide what the best option is for you.

Preventions

There are things you can do to reduce the risk of pelvic organ prolapse.

Exercising your pelvic floor



Do regular pelvic floor exercises to strength pelvic floor muscles maintain a healthy weight eat a high-fibre diet to avoid constipation or straining when you go to the toilet for a poo adopt good toilet habits avoid heavy lifting

How to exercise your pelvic floor muscles

Penile cancer
of cancer, cancer types in adults

Over the last 30 years, the number of penile cancer cases has increased by more than 20%, possibly due to changes in sexual practices.

However, improvements in diagnosis, staging and treatment have led to a similar reduction in the number of deaths resulting from the condition.


However, improvements in diagnosis, staging and treatment have led to a similar reduction in the number of deaths resulting from the condition.

Symptoms

You should be aware of any abnormalities or signs of penile cancer, including:

a growth or sore on the penis that doesn’t heal within 4 weeks  bleeding from the penis or from under the foreskin a foul-smelling discharge thickening of the skin of the penis or foreskin that makes it difficult to draw back the foreskin (phimosis) a change in the colour of the skin of the penis or foreskin a rash on the penis

If you experience these symptoms, it’s important that they’re checked by your GP as soon as possible. It’s unlikely they’ll be caused by cancer of the penis, but they need to be investigated.

Any delay in diagnosing penile cancer could reduce the chances of successful treatment.

Causes

The cause of penile cancer isn’t known, but certain risk factors can increase your chances of getting it.

Men who carry the human papilloma virus (HPV) have an increased risk of developing penile cancer, which is the virus that causes genital warts.

Age is also a risk factor for cancer of the penis. The condition rarely affects men and anyone with a penis under 40 years of age. It most commonly occurs in men and anyone with a penis aged over 60.

Smoking is the most significant lifestyle factor associated with penile cancer. Chemicals found in cigarettes can damage cells in the penis, which increases your risk of getting the condition.

Conditions that affect the penis, such as phimosis, which makes the foreskin difficult to retract, increase your chances of developing infections such as balanitis.

Repeated infections are linked to a higher risk of developing some types of penile cancer, because they can weaken your immune system.

The Cancer Research UK website has more information about the risks and causes of penile cancer.

Diagnoses

Your GP will ask you about any symptoms you have and when they occur. They’ll also examine your penis for signs of penile cancer.

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of penile cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected penile cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral.

If your GP suspects penile cancer, they may refer you to a specialist – usually a urologist (a doctor who specialises in conditions that affect the urinary system and genitals).

The specialist will ask about your symptoms and check your medical history. They may also check for any physical signs of penile cancer.

A blood test may be carried out to check your general health and the number of blood cells.

To confirm a diagnosis of penile cancer, you may need to have a biopsy. A small tissue sample will be removed so it can be examined under a microscope for cancerous cells.

Treatments

Treatment for penile cancer will depend on the size of the affected area and the rate at which the cancer has spread.

For example, in most cases of carcinoma in situ (CIS), where only the skin cells of the penis are affected, treatment will usually involve either using a chemotherapy cream or having laser surgery to remove the affected area of skin. You will usually have a skin graft after surgery.

The main treatments for penile cancer that isn’t at a very early stage are:

surgery radiotherapy chemotherapy

Surgery will involve removing the cancerous cells and possibly some of the surrounding tissue.

In most cases, any physical changes to your penis after an operation can be corrected with reconstructive surgery. Skin and muscle can be taken from elsewhere in the body to recreate a functioning penis.

However, with early diagnosis and modern surgical techniques, your surgeon will usually be able to preserve as much penile tissue as possible.

As part of most treatments for penile cancer, the lymph glands (small organs that are part of the immune system) in the groin will be assessed to determine if the cancer has spread.

The test that’s used, known as a sentinel node biopsy, is widely available in the UK. In some cases, the lymph glands may need to be surgically removed.

As with most types of cancer, the outlook for individual cases depends largely on how far the cancer has advanced at the time of diagnosis.

The Cancer Research UK website has more information about staging penile cancer and the types of treatment for cancer of the penis.

You can also read about penile cancer on the male cancer website Orchid. They also have a helpline you can phone – 0203 465 5766 (Monday to Friday, 9am to 5.30pm).

Preventions

It isn’t always possible to prevent penile cancer, but you can reduce your chances of getting it.

One of the main ways you can reduce your chances of developing penile cancer is to give up smoking (if you smoke).

It’s also important to maintain good penis hygiene to prevent the bacterial and viral infections that can increase the risk of penile cancer.

This is easier if you were circumcised as a child, but there are steps you can take if you haven’t been circumcised. Simple penis hygiene can include:

using condoms to help reduce the possibility of catching HPV regularly washing your penis with warm water, including under the foreskin

There’s little evidence to suggest that being circumcised as an adult will reduce your chances of developing penile cancer. However, if you have sores that don’t heal, or if it’s becoming increasingly difficult to clean under your foreskin, seek advice from your GP about the possibility of circumcision.

Peripheral neuropathy
of brain nerves and spinal cord

Peripheral neuropathy develops when nerves in the body’s extremities – such as the hands, feet and arms – are damaged. The symptoms depend on which nerves are affected.

In the UK, it’s estimated that almost 1 in 10 people aged 55 or over are affected by some degree of peripheral neuropathy.

Symptoms

The main symptoms can include:

numbness and tingling in the feet or hands burning, stabbing or shooting pain in affected areas loss of balance and co-ordination muscle weakness, especially in the feet

These symptoms are usually constant, but may come and go.

Read more about symptoms of peripheral neuropathy


Symptoms vary according to the type of peripheral neuropathy and may develop quickly or slowly.

The main types of peripheral neuropathy include:

sensory neuropathy – damage to the nerves that carry messages of touch, temperature, pain and other sensations to the brain motor neuropathy – damage to the nerves that control movement autonomic neuropathy – damage to the nerves that control involuntary bodily processes, such as digestion, bladder function and control of blood pressure mononeuropathy – damage to a single nerve outside of the central nervous system

In many cases, someone with peripheral neuropathy may have more than one of these types at the same time.

A combination of sensory and motor neuropathy is particularly common (sensorimotor polyneuropathy).

The symptoms of the main types of peripheral neuropathy are described below.


In addition to treating pain, you may also require treatment to help you manage other symptoms you’re experiencing as a result of peripheral neuropathy.

For example, if you have muscle weakness, you may need physiotherapy to learn exercises to improve your muscle strength. You may also need to wear splints to support weak ankles or use walking aids to help you get around.

Other problems associated with peripheral neuropathy may be treatable with medication, such as:

erectile dysfunction constipation the slow movement of food through your stomach (gastroparesis)

In some cases, you may need more invasive treatment, such as botulinum toxin injections for hyperhidrosis or urinary catheterisation if you have problems emptying your bladder.

Causes

In the UK, diabetes (both type 1 and type 2) is the most common cause of peripheral neuropathy.

Over time, the high blood sugar levels associated with diabetes can damage the nerves. This type of nerve damage is known as diabetic polyneuropathy.

Peripheral neuropathy can also have a wide range of other causes. For example, it can be caused by:

physical injury to the nerves a viral infection such as shingles a side effect of certain medications or drinking too much alcohol

People who are known to be at an increased risk of peripheral neuropathy may have regular check-ups so their nerve function can be assessed.

Read more about the causes of peripheral neuropathy


Diabetes is the most common cause of peripheral neuropathy in the UK.

Neuropathy can also be caused by other health conditions and certain medications. In some cases, no cause can be identified and this is termed idiopathic neuropathy.


As well as diabetes, there are many other possible causes of peripheral neuropathy.

Health conditions

Some of the health conditions that can cause peripheral neuropathy include:

excessive alcohol drinking for years low levels of vitamin B12 or other vitamins physical damage to the nerves – such as from an injury or during surgery an underactive thyroid gland (hypothyroidism) certain infections – such as shingles, Lyme disease, diphtheria, botulism and HIV inflammation of the blood vessels (vasculitis) chronic liver disease or chronic kidney disease monoclonal gammopathy of undetermined significance (MGUS) – the presence of an abnormal protein in the blood certain types of cancer, such as lymphoma (a cancer of the lymphatic system) and multiple myeloma (a type of bone marrow cancer) Charcot-Marie-Tooth (CMT) disease and other types of hereditary motor sensory neuropathy – genetic conditions that cause nerve damage, particularly in the feet having high levels of toxins in your body, such as arsenic, lead or mercury Guillain-Barré syndrome – a rare condition that causes rapid onset of paralysis within days amyloidosis – a group of rare but serious conditions caused by deposits of abnormal protein called amyloid in tissues and organs throughout the body conditions caused by overactivity of the immune system – such as rheumatoid arthritis, lupus or Sjogren’s syndrome

Medication

A few medications may sometimes cause peripheral neuropathy as a side effect in some people. These include:

some types of chemotherapy for cancer – especially for bowel cancer, lymphoma or myeloma some antibiotics, if taken for months – such as metronidazole or nitrofurantoin phenytoin – used to treat epilepsy – if taken for a long time  amiodarone and thalidomide


Your GP can usually identify the underlying cause of a peripheral neuropathy.

If diabetes is suspected, they can usually make a confident diagnosis based on your symptoms, a physical examination and checking the levels of glucose in your blood and urine.

If you’re taking a medication known to cause peripheral neuropathy, your GP may temporarily stop or reduce your dose to see whether your symptoms improve.

If the cause is uncertain, you may be referred to a neurologist for more extensive blood tests to check:

whether you have a rare acquired cause that may be responsible whether you have a genetic abnormality, such as Charcot-Marie-Tooth disease

You may need a lumbar puncture to test the cerebrospinal fluid (a clear, colourless fluid that surrounds and supports the brain and spinal cord) for inflammation.


There are many different possible causes of peripheral neuropathy, some of which can be treated in different ways. For example:

diabetes can sometimes be controlled by lifestyle changes, such as stopping smoking, cutting down on alcohol, maintaining a healthy weight and exercising regularly vitamin B12 deficiency can be treated with B12 injections or tablets peripheral neuropathy caused by a medication you’re taking may improve if the medication is stopped

Some less common types of peripheral neuropathy may be treated with medication, such as:

corticosteroids – powerful anti-inflammatory medication immunosuppressants – medications that reduce the activity of the immune system injections of immunoglobulin – mixture of blood proteins called antibodies made by the immune system

However, the underlying cause may not always be untreatable.

Diagnoses

A number of tests may be used to diagnose peripheral neuropathy and its underlying cause.

When you see your GP, they’ll ask about your symptoms and examine the affected area of your body. This may involve testing sensation, strength and reflexes.

Your doctor may also arrange blood tests, especially to check for causes such as diabetes or vitamin B12 deficiency.


Occasionally, a nerve biopsy may be carried out as part of your diagnosis. This is a minor surgical procedure where a small sample of a peripheral nerve is removed from near your ankle so it can be examined under a microscope.

It’s then checked for changes that could be a sign of certain types of peripheral neuropathy. However, nerve biopsies are rarely needed.

You may also need a scan to look for any underlying cause of your neuropathy, such as:

an X-ray a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan

Treatments

It’s important to see your GP if you experience the early symptoms of peripheral neuropathy, such as: pain, tingling or loss of sensation in the feet loss of balance or weakness a cut or ulcer on your foot that isn’t getting better

It’s recommended that people at highest risk of peripheral neuropathy, such as people with diabetes, have regular check-ups.

Your GP will ask about your symptoms and may arrange some tests to help identify the underlying cause. You may be referred to a hospital to see a neurologist (a specialist in conditions affecting the nervous system).

Generally, the sooner peripheral neuropathy is diagnosed, the better the chance of limiting the damage and preventing further complications.

Read more about diagnosing peripheral neuropathy


Treatment for peripheral neuropathy depends on the symptoms and underlying cause.

Only some of the underlying causes of neuropathy can be treated. For example, if you have diabetes it may help to gain better control of your blood sugar level, stop smoking, and cut down on alcohol.

Nerve pain may be treated with prescribed medications called neuropathic pain agents, as standard painkillers are often ineffective.

If you have other symptoms, these may need to be treated individually. For example, treatment for muscle weakness may involve physiotherapy and the use of walking aids.

Read more about treating peripheral neuropathy.


Treatment for peripheral neuropathy may include treating any underlying cause or any symptoms you’re experiencing.

Treatment may be more successful for certain underlying causes. For example, ensuring diabetes is well controlled may help improve neuropathy or at least stop it getting worse.


There are many different possible causes of peripheral neuropathy, some of which can be treated in different ways. For example:

diabetes can sometimes be controlled by lifestyle changes, such as stopping smoking, cutting down on alcohol, maintaining a healthy weight and exercising regularly vitamin B12 deficiency can be treated with B12 injections or tablets peripheral neuropathy caused by a medication you’re taking may improve if the medication is stopped

Some less common types of peripheral neuropathy may be treated with medication, such as:

corticosteroids – powerful anti-inflammatory medication immunosuppressants – medications that reduce the activity of the immune system injections of immunoglobulin – mixture of blood proteins called antibodies made by the immune system

However, the underlying cause may not always be untreatable.


In addition to treating pain, you may also require treatment to help you manage other symptoms you’re experiencing as a result of peripheral neuropathy.

For example, if you have muscle weakness, you may need physiotherapy to learn exercises to improve your muscle strength. You may also need to wear splints to support weak ankles or use walking aids to help you get around.

Other problems associated with peripheral neuropathy may be treatable with medication, such as:

erectile dysfunction constipation the slow movement of food through your stomach (gastroparesis)

In some cases, you may need more invasive treatment, such as botulinum toxin injections for hyperhidrosis or urinary catheterisation if you have problems emptying your bladder.

Complications

The outlook for peripheral neuropathy varies, depending on the underlying cause and which nerves have been damaged.

Some cases may improve with time if the underlying cause is treated, whereas in some people the damage may be permanent or may get gradually worse with time.

If the underlying cause of peripheral neuropathy isn’t treated, you may be at risk of developing potentially serious complications, such as a foot ulcer that becomes infected. This can lead to gangrene (tissue death) if untreated, and in severe cases may mean the affected foot has to be amputated.

Peripheral neuropathy may affect the nerves controlling the automatic functions of the heart and circulation system (cardiovascular autonomic neuropathy). You may need treatment to increase your blood pressure or, in rare cases, a pacemaker.

Read more about complications of peripheral neuropathy


Peripheral neuropathy can sometimes cause other medical problems, such as foot ulcers and heart rhythm changes, and blood circulation problems.

These complications vary depending on the underlying cause of the condition.

Personality disorder
of mental health

think perceive feel relate to others

Changes in how a person feels and distorted beliefs about other people can lead to odd behaviour. This can be distressing and may upset others.



being overwhelmed by negative feelings like distress, anxiety, worthlessness or anger avoiding other people feeling empty and emotionally disconnected odd behaviour difficulty maintaining stable and close relationships, especially with partners, children and professional carers periods of losing contact with reality

Some people may also have difficulty managing negative feelings without self-harming. This can include abusing drugs and alcohol or taking overdoses. In rare cases, it may include threatening other people.

People with personality disorders often experience other mental health problems. This includes depression and substance misuse.

Symptoms typically get worse with stress.

Causes

Personality disorders are common mental health problems.

They usually emerge in adolescence and continue into adulthood. They may be mild, moderate or severe. People may have periods of “remission” where they function well.

Personality disorders may be associated with genetic and family factors. Experiences of distress or fear during childhood, like neglect or abuse, are common.

Many people have only mild conditions so only need help at times of stress (such as bereavement). People with more severe problems may need specialist help for longer.

Treatments

Personality disorders are common mental health problems.

They usually emerge in adolescence and continue into adulthood. They may be mild, moderate or severe. People may have periods of “remission” where they function well.

Personality disorders may be associated with genetic and family factors. Experiences of distress or fear during childhood, like neglect or abuse, are common.

Many people have only mild conditions so only need help at times of stress (such as bereavement). People with more severe problems may need specialist help for longer.


Many people recover from personality disorders over time.

Treatment usually involves a course of psychological therapy tailored to the individual. This treatment usually lasts at least 6 months. But, it may last longer depending on the severity of the condition and other problems.

Psychological therapies

Psychotherapy involves discussing thoughts, emotions and behaviours with a trained professional. The aim is to improve people’s ability to regulate their thoughts and emotions.

Some therapies focus on dysfunctional thoughts. Others focus on self-reflection and being aware of how your mind works. Some therapies, especially group therapies, help people understand social relationships better.

Psychological therapies can be effective for many personality disorders. But, they should only be delivered by a trained professional. They should have experience working with personality disorders and other conditions. This is because personality disorders can be associated with high-risk behaviours, like self-harm.

The psychotherapist will listen and discuss important issues with you. They can also suggest strategies to resolve problems. If necessary, they’ll help you change your attitudes and behaviour.

A range of different psychotherapies are used to treat personality disorders.

Read more about types of counselling and therapy

Medication

No medications are currently licensed for the treatment of any personality disorder. But, medications may be prescribed to treat associated problems, like:

depression anxiety psychotic symptoms

Pleurisy
of lungs and airways

Pleurisy is inflammation of the sheet-like layers that cover the lungs (the pleura).

The most common symptom of pleurisy is a sharp chest pain when breathing deeply. Sometimes the pain is also felt in the shoulder.

The pain may be worse when you cough, sneeze or move around, and it may be relieved by taking shallow breaths.

Other symptoms can include shortness of breath and a dry cough.

Visit your GP if you experience the above symptoms. Seek immediate medical help if your chest pain is severe, particularly if you also have other symptoms, such as coughing up blood, nausea or sweating.

Causes

Most cases are the result of a viral infection (such as the flu) or a bacterial infection (such as pneumonia).

In rarer cases, pleurisy can be caused by conditions such as a blood clot blocking the flow of blood into the lungs (pulmonary embolism) or lung cancer.

Pleurisy can affect people of all ages, but people of 65 years and over are most at risk, because they’re more likely to develop a chest infection.

Read more about the causes of pleurisy.


Pleurisy is inflammation of the pleura. It’s usually caused by another condition, such as an infection, but sometimes no cause can be identified.

The pleura are two thin sheets of tissue that separate the lungs and ribcage. One is attached to the ribcage and the other is attached to the lungs.

Between the pleural sheets is a thin layer of liquid that lubricates the pleura, helping to reduce friction when you breathe in and out.

When there’s inflammation, the surfaces of the two layers can become rough and the fluid can become sticky. This can cause the layers to rub together, resulting in pain and discomfort.


Other possible causes of pleurisy include:

injury – if the ribs are bruised or fractured, the pleura can become inflamed pulmonary embolism – a blood clot developing inside the lungs sickle cell anaemia – a blood disorder that usually affects people of African or Caribbean descent chemotherapy and radiotherapy HIV or AIDS lung cancer mesothelioma – a type of cancer caused by inhaling asbestos

Autoimmune conditions, such as rheumatoid arthritis and lupus, are other possible causes of pleurisy. In these conditions, something goes wrong with the immune system (the body’s natural defence against infection and illness) and it begins to attack healthy tissue.


It may also be necessary to treat the underlying cause of your pleurisy.

If you have pleurisy caused by a bacterial infection, you’ll need a course of antibiotics. Depending on the severity of your symptoms, this may be either tablets or injections. Combinations of different antibiotics are sometimes used.

However, if your pleurisy is caused by a viral infection, further treatment may not be required, as the infection usually resolves itself after a few days.

In cases where your symptoms are particularly severe or you’re already in poor health, you may need to be admitted to hospital so your body’s functions can be supported until your condition stabilises.

Treatments

Treatment for pleurisy depends on the underlying cause.

For example, pleurisy caused by a viral infection will often resolve itself without treatment. However, pleurisy caused by a bacterial infection is usually treated with antibiotics, and people who are frail or already in poor health may be admitted to hospital.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often used to relieve the chest pain associated with pleurisy.

If excess fluid builds up between the pleural layers, it may be necessary to drain the fluid to prevent breathing difficulties.

Read more about treating pleurisy.


Treatment for pleurisy usually involves relieving pain and treating the underlying cause of the condition.

If treated promptly, pleurisy often resolves without any lasting damage to the lungs.


The chest pain associated with pleurisy can be treated using a type of painkiller known as non-steroidal anti-inflammatory drugs (NSAIDs). Most often, ibuprofen is used.

If NSAIDs are ineffective or unsuitable, you may be prescribed another painkiller, such as paracetamol or codeine.

It may seem strange, but lying down on the side of your chest that hurts may also help to reduce the pain.


It may also be necessary to treat the underlying cause of your pleurisy.

If you have pleurisy caused by a bacterial infection, you’ll need a course of antibiotics. Depending on the severity of your symptoms, this may be either tablets or injections. Combinations of different antibiotics are sometimes used.

However, if your pleurisy is caused by a viral infection, further treatment may not be required, as the infection usually resolves itself after a few days.

In cases where your symptoms are particularly severe or you’re already in poor health, you may need to be admitted to hospital so your body’s functions can be supported until your condition stabilises.

Pneumonia
of lungs and airways

Pneumonia is swelling (inflammation) of the tissue in one or both lungs. It’s usually caused by a bacterial infection.

At the end of the breathing tubes in your lungs are clusters of tiny air sacs. If you have pneumonia, these tiny sacs become inflamed and fill up with fluid.

Symptoms

The symptoms of pneumonia can develop suddenly over 24 to 48 hours, or they may come on more slowly over several days.

Common symptoms of pneumonia include:

a cough – which may be dry, or produce thick yellow, green, brown or blood-stained mucus (phlegm) difficulty breathing – your breathing may be rapid and shallow, and you may feel breathless, even when resting rapid heartbeat fever feeling generally unwell sweating and shivering loss of appetite chest pain – which gets worse when breathing or coughing

Less common symptoms include:

coughing up blood (haemoptysis) headaches fatigue nausea or vomiting wheezing joint and muscle pain feeling confused and disorientated, particularly in elderly people

When to see your GP

See your GP if you feel unwell and you have typical symptoms of pneumonia.

Seek urgent medical attention if you’re experiencing severe symptoms, such as rapid breathing, chest pain or confusion.

Causes

Pneumonia is usually the result of a pneumococcal infection, caused by bacteria called Streptococcus pneumoniae.

Many different types of bacteria, including Haemophilus influenzae and Staphylococcus aureus, can also cause pneumonia, as well as viruses and, more rarely, fungi.

As well as bacterial pneumonia, other types include:

viral pneumonia – most commonly caused by the respiratory syncytial virus (RSV) and sometimes influenza type A or B; viruses are a common cause of pneumonia in young children aspiration pneumonia – caused by breathing in vomit, a foreign object, such as a peanut, or a harmful substance, such as smoke or a chemical fungal pneumonia – rare in the UK and more likely to affect people with a weakened immune system hospital-acquired pneumonia – pneumonia that develops in hospital while being treated for another condition or having an operation; people in intensive care on breathing machines are particularly at risk of developing ventilator-associated pneumonia

Risk groups

The following groups have an increased risk of developing pneumonia:

babies and very young children elderly people people who smoke people with other health conditions, such as asthma, cystic fibrosis, or a heart, kidney or liver condition people with a weakened immune system – for example, as a result of a recent illness, such as flu, having HIV or AIDS, having chemotherapy, or taking medication following an organ transplant

Diagnoses

Your GP may be able to diagnose pneumonia by asking about your symptoms and examining your chest. Further tests may be needed in some cases.

Pneumonia can be difficult to diagnose because it shares many symptoms with other conditions, such as the common cold, bronchitis and asthma.

To help make a diagnosis, your GP may ask you:

whether you feel breathless or you’re breathing faster than usual how long you’ve had your cough, and whether you’re coughing up mucus and what colour it is if the pain in your chest is worse when you breathe in or out

Your GP may also take your temperature and listen to your chest and back with a stethoscope to check for any crackling or rattling sounds.

They may also listen to your chest by tapping it. Lungs filled with fluid produce a different sound from normal healthy lungs.

If you have mild pneumonia, you probably won’t need to have a chest X-ray or any other tests.

You may need a chest X-ray or other tests, such as a sputum (mucus) test or blood tests, if your symptoms haven’t improved within 48 hours of starting treatment.

Treatments

Mild pneumonia can usually be treated at home by:

getting plenty of rest taking antibiotics drinking plenty of fluids

If you don’t have any other health problems, you should respond well to treatment and soon recover, although your cough may last for some time.

As pneumonia isn’t usually passed from one person to another, it’s safe to be around others, including family members.

However, people with a weakened immune system should avoid close contact with a person with pneumonia until they start to get better.

For at-risk groups, pneumonia can be severe and may need to be treated in hospital.

This is because it can lead to serious complications, which in some cases can be fatal, depending on a person’s health and age.

Read more about treating pneumonia.


Mild pneumonia can usually be treated at home with rest, antibiotics and by drinking plenty of fluids. More severe cases may need hospital treatment.

Unless a healthcare professional tells you otherwise, you should always finish taking a prescribed course of antibiotics, even if you feel better.

If you stop taking an antibiotic part way through a course, the bacteria can become resistant to the antibiotic.

After starting treatment, your symptoms should steadily improve.

However, how quickly they improve will depend on how severe your pneumonia is. 

As a general guide, after:

one week – fever should have resolved four weeks – chest pain and mucus production should have substantially reduced six weeks – cough and breathlessness should have substantially reduced three months – most symptoms should have resolved, but you may still feel very tired (fatigue) six months – most people will feel back to normal


Visit your GP if your symptoms don’t improve within three days of starting antibiotics.

Symptoms may not improve if:

the bacteria causing the infection is resistant to antibiotics – your GP may prescribe a different antibiotic, or they may prescribe a second antibiotic for you to take with the first one a virus is causing the infection, rather than bacteria – antibiotics have no effect on viruses, and your body’s immune system will have to fight the viral infection by creating antibodies

Painkillers, such as paracetamol or ibuprofen, may help relieve pain and reduce fever.

However, you shouldn’t take ibuprofen if you:

are allergic to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) have asthma, kidney disease, a history of stomach ulcers or indigestion

Cough medicines aren’t recommended as there’s also little evidence they are effective. A warm honey and lemon drink can help relieve discomfort caused by coughing.

Your cough may persist for two to three weeks after you finish your course of antibiotics, and you may feel tired for even longer as your body continues to recover.

Drink plenty of fluids to avoid dehydration, and get plenty of rest to help your body recover.

If you smoke, it’s more important than ever to stop, as smoking damages your lungs.

Read more about stop smoking treatments and how to stop smoking.

See your GP if, after following the above self-help measures, your condition is deteriorating or isn’t improving as expected.

Pneumonia isn’t usually passed from one person to another, so it’s safe to be around others, including family members.

However, it’s best for people with a weakened immune system to avoid close contact with a person with pneumonia until they start to get better.

Follow-up

Your GP will probably arrange a follow-up appointment for you about six weeks after you start your course of antibiotics.

In some cases, they may arrange follow-up tests, such as a chest X-ray, if:

your symptoms haven’t improved your symptoms have come back you smoke you’re over the age of 50

Some people may be advised to have a flu vaccination or pneumococcal vaccination after recovering from pneumonia.

Read more about preventing pneumonia.


You may need treatment in hospital if your symptoms are severe. You’ll be given antibiotics and fluids intravenously through a drip, and you may need oxygen to help breathing.

In very serious cases of pneumonia, breathing assistance through a ventilator in an intensive care unit (ICU) may be required.

Read more about the complications of pneumonia.

Preventions

Although most cases of pneumonia are bacterial and aren’t passed on from one person to another, ensuring good standards of hygiene will help prevent germs spreading.

For example, you should:

cover your mouth and nose with a handkerchief or tissue when you cough or sneeze  throw away used tissues immediately – germs can live for several hours after they leave your nose or mouth wash your hands regularly to avoid transferring germs to other people or objects

A healthy lifestyle can also help prevent pneumonia. For example, you should avoid smoking as it damages your lungs and increases the chance of infection.

Find out how to stop smoking.

Excessive and prolonged alcohol misuse also weakens your lungs’ natural defences against infections, making you more vulnerable to pneumonia.

People at high risk of pneumonia should be offered the pneumococcal vaccine and flu vaccine.

Complications

Complications of pneumonia are more common in young children, the elderly and those with pre-existing health conditions, such as diabetes.

Possible complications of pneumonia include:

pleurisy – where the thin linings between your lungs and ribcage (pleura) become inflamed, which can lead to respiratory failure a lung abscess – a rare complication that’s mostly seen in people with a serious pre-existing illness or a history of severe alcohol misuse blood poisoning (septicaemia) – also a rare but serious complication

You’ll be admitted to hospital for treatment if you develop one of these complications.

Polymyalgia rheumatica
of muscle bone and joints, conditions

Polymyalgia rheumatica (PMR) is a condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips.

The main symptom is muscle stiffness in the morning that lasts longer than 45 minutes. It may also cause other symptoms, including:

high temperature (fever) and sweating extreme tiredness (fatigue) loss of appetite weight loss depression

If you have pain and stiffness that lasts longer than a week, you should see your GP so the cause can be investigated.

Diagnosing polymyalgia rheumatica can be difficult because the symptoms are similar to those of many other conditions, including rheumatoid arthritis. These conditions will need to be ruled out before polymyalgia rheumatica is diagnosed.

Read more about the symptoms of polymyalgia rheumatica and diagnosing polymyalgia rheumatica.

Symptoms

The most common symptom of polymyalgia rheumatica (PMR) is pain and stiffness in the shoulder muscles, which develops quickly over a few days or weeks.

The muscles in the neck and hips are also often affected. Both sides of the body are usually affected.

The stiffness often feels worse first thing in the morning after you wake up and starts to improve after about 45 minutes as you become more active.

Some people with polymyalgia rheumatica have additional symptoms, including:

a mild high temperature (fever) of 37-38C (98.6-100.4F) depression fatigue (extreme tiredness) loss of appetite weight loss


After other possible causes of your symptoms have been ruled out, a checklist can be used to see whether your symptoms match those most commonly associated with polymyalgia rheumatica.

A confident diagnosis of polymyalgia rheumatica can usually be made if you meet all of the following criteria:

you’re over 50 years of age  you have pain in your shoulders or your hips you have stiffness in the morning that lasts longer than 45 minutes your symptoms have lasted longer than two weeks blood tests show raised levels of inflammation in your body your symptoms rapidly improve after treatment with corticosteroids

Read more about treating polymyalgia rheumatica.

Causes

The cause of polymyalgia rheumatica is unknown, but a combination of genetic and environmental factors is thought to be responsible.

Polymyalgia rheumatica is relatively common in the UK. It’s estimated that one in every 1,200 people develop the condition every year.

Polymyalgia rheumatica is age-related. Most people who are diagnosed with the condition are over 70. It’s extremely rare in people younger than 50. It’s also more common in women than men.

Diagnoses

Diagnosing polymyalgia rheumatica (PMR) can often be quite a lengthy process that involves several different tests.

This is because the condition shares many symptoms with more common health conditions, such as rheumatoid arthritis, which need to be ruled out first.


There’s no specific test for polymyalgia rheumatica, but it’s likely that a series of blood tests will be carried out.

Two blood tests – erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) – can be used to check the levels of inflammation in your body.

If the ESR and CRP test results are normal, it’s unlikely that polymyalgia rheumatica will be diagnosed because your doctor won’t want to prescribe a long-term course of steroids if the diagnosis is uncertain. Sometimes, the ESR may be normal and CRP may be raised, which would be more likely to indicate a positive diagnosis. This is why both tests are usually carried out at the same time.

As inflammation is a characteristic of many conditions, high levels don’t automatically mean that you have polymyalgia rheumatica. Further tests may be needed to help rule out other conditions that cause inflammation. For example, a test for rheumatoid factor and anti-CCP antibodies, may be carried out to rule out rheumatoid arthritis.

Blood tests can also help determine:

whether there’s an infection in your blood how well some of your organs, such as your kidneys, are working whether you have an overactive thyroid gland or an underactive thyroid gland (both conditions can cause muscle pain)

You may also have a urine test to check how well your liver is functioning.

X-rays and ultrasound scans may also be used to look at the condition of your bones and joints.

Treatments

The main treatment for polymyalgia rheumatica is a coritcosteroid medication called prednisolone, which is used to help relieve the symptoms.

You’ll initially be prescribed a high dose of prednisolone, which will be reduced gradually over time.

Most people with polymyalgia rheumatica will need to take a long-term course of corticosteroid treatment (lasting 18 months to two years) to prevent their symptoms returning.

Read more about treating polymyalgia rheumatica.


If you have symptoms of pain and stiffness that last longer than a week, you should make an appointment to see your GP so that the cause can be investigated.


You should seek immediate medical advice if you have been diagnosed with polymyalgia rheumatica (or the condition is suspected) and you suddenly develop:

a persistent and severe headache jaw pain or cramping in your jaw muscles which is worse when you’re eating pain in the tongue when chewing  vision loss or vision disturbances, such as double vision

These symptoms may indicate a more serious condition called giant cell arteritis (temporal arteritis).

Call your GP immediately for advice if you have any of the above symptoms. If this isn’t possible, contact your local out of hours service or call the NHS 24 ‘111’ service.


Steroid medication (corticosteroids) is the preferred treatment for polymyalgia rheumatica (PMR).

A type of corticosteroid called prednisolone is usually prescribed.