Rheumatology - Polymyalgia Rheumatica

Question 1

Who is most commonly affected by PMR?

Answer 1

Older white patients

Question 2

How does PMR present?

Answer 2

Pain and stiffness in
Shoulders
Pelvic girdle
Neck

Question 3

What are the characteristic features of pain and stiffness in PMR?

Answer 3

Worse in the morning
Worse after rest of inactivity
Affects sleep
Takes 45 minutes to ease

Question 4

What are the associated features of PMR?

Answer 4

Systemic symptoms
Muscle tenderness
Carpal tunnel syndrome
Peripheral oedema

Strong link to GCA

Question 5

How is PMR diagnosed?

Answer 5

Clinical presentation
Response to steroids
Excluding differentations

Raised ESR and CRP (can be normal)

Question 6

Before starting steroids what investigations need to be used?

Answer 6

FBC
U&Es
LFTs

Calcium
Serum protein electrophoresis (myeloma)
TSH
Creatine kinase (myositis)
Rheumatoid factor
Urine dip

Question 7

How is PMR treated?

Answer 7

15mg prednisolone

1 week follow up

For 1-2 years
Reducing regime
Reduce by 1mg every 4-8 weeks

Question 8

What is the additional management for patients on long-term steroids?

Answer 8

DON’T STOP

Don’t Steroid dependence occurs after 3 weeks, stopping abruptly can cause adrenal crisis

Sick day rules
Treatment card
Osteoporosis
PPis for gastroprotection