PMR

Question 1

rarely occurs before age 50

common: in older persons prevalence approaches that of rheumatoid arthritis (approx 1 percent)

F:M 2:1, north latitudes, caucasians

HLA-DR4

screen for paraneoplastic syndrome

Answer 1

polymyalgia rheumatica PMR

Question 2

main tx?

Answer 2

sensitive to low dose steroids <20mg/day

response is dramatic; if not, rethink diagnosis

tx is 1-2 yrs

Question 3

PMR is present in about 50 percent of patients with this?

signs:

Answer 3

GCA, giant cell arteritis

headache, scalp tenderness, visual changes, jaw claudication, prominent temporal arteries

Question 4

what steroid should be used with this?

Answer 4

prednisone

1/3 do well on this, tapered and d/c

1/3 require some DMARD to taper prednisone

1/3 or more progress to RA and so DMARD or biologic required, positive RF/CCP can develop