Polymyalgia Rheumatica Flashcards
What is PMR and how does it present?
What are some of the systemic signs?
-Rheumatic conditions, affects the shoulder and hip girdles, secondary to low grade synovitis
FEATURES:
Early morning stiffness, symmetrical.
Pain can involve neck, upper arms, lower back and thigshs.
Other areas affected:
Carpel Tunnel Syndrome
Non erosive asymmetrical peripheral arthritis (knees and small joints of hands and knees)
2/Fever, depression, fatigue, anorexia and weight loss in 40% of patients.
(ref: RACGP article PMR diagnosis and mangement)
Giant Cell Arteritis is associated with PMR, when would you investigate for it?
New headache or unexplanied pain above the neck, high inflammatory markers.
What is the diagnostic criteria for PMR?
Age ≥50 years with new bilateral shoulder pain
New hip involvement (pain, tenderness, limited movement)
Morning stiffness for >45 min
Other joints other than hip & shoulder not involved
Elevated C-reactive protein and/or ESR
Rh and Anti CCP negative
(ref etg & RACGP article PMR diagnosis and mangement)
Investigations for PMR?
FBC, UEC, LFT’s, CMP
ESR, CRP
Protein Electrophoresis (multiple myelom)
TSH
Creatinine Kinase
Rheumatoid factor (consider ANA, Anti-CCP)
Dipstick urinanalysis
(ref: RACGP article PMR diagnosis and mangement)
Conditions that mimic PMR?
Vascular - Giant Cell Arteritis Infection Neoplasm - MM, lymphoma, leukemia Drugs induced - statin myopathy Endocrine - hypothyroidism
Rheumatic disease
- late onset spondyloarthropathy, rheumatoid arthritis
- SLE or connective tissue disorder
- polymyositis
- fibromyalgia
- pseudogout
Chronic pain syndrome
local hip or shoulder pathology
(ref: RACGP article PMR diagnosis and mangement)
1/ Management
1/ low dose steroid therapy (can start at 15mg / day for eg.) Treatments usually req’d for 12 months (Ref:etg)
(ref: RACGP article PMR diagnosis and mangement)
What % of patients with PMR will also have GCA?
15%
Ref Etg
What are the side effects of corticosteroids?
• Increased risk of infection
Endocrine
• Cushing syndrome
Osteoporosis
MSK
• Weight gain
Dermatology
• Skin bruising
Cardiac
• Raised blood pressure
• Impaired blood glucose
• Cardiac failure
Psychological
• Depression
Eyes
• Cataracts
• Glaucoma
(ref: RACGP article PMR diagnosis and mangement)
What is the diagnostic criteria of GCA?
Age >50 years New onset of localised headache Temporal artery tenderness or decreased temporal artery pulse ESR ≥50 mm/hr Positive temporal artery biopsy
(PMR a clinical update, racgp 2014)