7: Polymyalgia Rheumatica

Question 1

Name clinical features of polymyalgia rheumatica (6)?

Answer 1

1. 50 + (usually 70+).
2. Acute onset pain for weeks in 2 or more axial areas (neck, shoulders, pelvic girdle).
3. Morning stiffness 1+ hour.
4. Rapid response to low-dose steroids (Prednisone 20 mg/day or less).
5. Absence of other explanation.
6. ESR of 40+.

Question 2

Polymyalgia rheumatica is associated with _____.

Answer 2

Giant Cell Arteritis

Question 3

What is the treatment if a patient with polymyalgia rheumatica has visual changes, jaw pain, and scalp tenderness?

Answer 3

Emergency. Could be giant cell arteritis. High dose of steroids to prevent blindness.

Question 4

What is the treatment for polymyalgia rheumatica?

Answer 4

Low-dose Prednisone (15-20 mg/day) that is tapered to lowest dose and continues for at least a year.

Question 5

Why should treatment last at least 1 year?

Answer 5

Recurrent is 70% if treatment is <1 year but only 30% if treatment is >1 year.

Question 6

What is a good taper for polymyalgia rheumatica?

Answer 6

Begin at 20 mg/day for 2 months. Decrease by 5 mg q 2 months until 5 mg/day. Keep patient at 5 mg/day for remainder of full year. Then decrease by 1 mg every month until taper complete.

Question 7

If a patient fails 2 attempts to taper Prednisone, what treatment is used?

Answer 7

Methotrexate. Increase Prednisone to the lowest effective dose, then add Methotrexate.

Question 8

Why is increasing Prednisone to 20 mg/day not appealing if they fail the taper?

Answer 8

Unnecessary risk of toxicity.

Question 9

Why is adding infliximab not an appealing option for patients who fail the Prednisone taper?

Answer 9

Not shown to be effective in polymyalgia rheumatica.