Polymyalgia Rheumatica

Question 1

Define polymyalgia rheumatica

Answer 1

Inflammatory rheumatological syndrome that manifests as a pain and morning stiffness in individuals >50

Question 2

Aetiology and risk factors of polymyalgia rheumatica

Answer 2

Aetiology
- Exact cause unknown
- Suggested role of infectious agents e.g. adenovirus, RSV, parvovirus B18, chlamydia pneumoniae, Mycoplasma pneumoniae
- Suggested role of genetic factors e.g. HLA-DRB1*04
- Association with giant cell arteritis

Risk Factors:
- >50
- Giant cell arteritis
- Female

Question 3

Symptoms of polymyalgia rheumatica

Answer 3

Shoulder/hip girdle stiffness and pain (>1 hour, acute, bilateral, worse in the morning)
Low-grade fever
Anorexia, weight loss, depression, malaise
Asthenia (unaccustomed physical weakness or lack of energy)

NO WEAKNESS

Question 4

Signs of polymyalgia rheumatica

Answer 4

Tenderness over the greater trochanteric and subacromial bursae
Restricted shoulder movements/hip movements

Question 5

Investigations for polymyalgia rheumatica

Answer 5

FRAX score: if considering steroids

ESR/CRP: raised
FBC/blood film/electrophoresis: ?myeloproliferative disease
CK: normal
LFTs/bone profile: raise ALP
TFTs: ?hypoT

US/MRI joint: ?bursitis, joint effusion (trochanteric most common)

Question 6

Management for polymyalgia rheumatica

Answer 6

1. PO steroid e.g. prednisolone PO 12.5-25mg once daily then taper (reduce)
   +/- calcium, vit D, bisphosphonate (colecalciferol, calcium carbonate, alendronic acid)
   ± NSAIDs e.g. naproxen
2. Methotrexate + folic acid
3. Tocilizumab

Question 7

Prognosis for polymyalgia rheumatica

Answer 7

Ass. with giant cell arteritis
Overall prognosis is good
Response to treatment typically occurs within 24-72 hours, and requires 2-3 years total
Relapses or symptom exacerbations are common
If GCA is present, prognosis and treatment is directly related to GCA
Increased risk of relapse or prolonged therapy associated with female sex, high ESR, and peripheral arthritis