Polymyalgia Rheumatica

Question 1

Define polymyalgia rheumatica (PMR)

Answer 1

Inflammatory rheumatological syndrome that manifests as pain and morning stiffness involving the neck, shoulder girdle, and/or pelvic girdle in individuals older than age 50 years.

Question 2

Epidemiology

Answer 2

Increases with increasing age
Esp in females
Esp in northern European populations

Question 3

Aetiology/risk factors

Answer 3

Associated with giant cell arteritis
Female
Over 50

Question 4

Which sites are affected?

Answer 4

Neck
Shoulders
Pelvis

Question 5

Symptoms

Answer 5

Pain in neck, shoulder or pelvis
Asthenia
Malaise
Depression

Constitutional symptoms: 
Low grade fever
Anorexia
Weight loss 
Oligoarticular arthritis

Question 6

What is asthenia?

Answer 6

Physical weakness

Question 7

How quickly does the pain develop and when do patients present?

Answer 7

Acutely, however patients don’t present until a few weeks later

Question 8

What is oligoarticular arthritis and which joints are typically involved?

Answer 8

Less than 4?
Wrists - MCP
Knees

Question 9

Investigations

Answer 9

ESR > 40mm/hr (however this might be normal in 20%)
CRP elevated
FBC (other myeloproliferative diseases can masquerade)
Ultrasound

Question 10

Why do you do an ultrasound?

Answer 10

Bursitis is commonly found in PMR, especially trochanteric bursitis

Question 11

Treatment (1st and second line)

Answer 11

1st line: 15mg oral prednisolone
2nd line: intramuscular methylprednis
+ calcium, vit D, bisphosphonates e.gl alendronic acid

Question 12

When do patients respond?

Answer 12

Usually gets better within 20 hrs however treatment for at least a year is recommended to prevent relapse

Question 13

Give four complications of steroid therapy

Answer 13

T2DM
Osteoporosis
Cataracts
Avascular necrosis

Question 14

What do you need to screen for?

Answer 14

Giant cell arteritis

Question 15

Diagnosis

Answer 15

High ESR
Typical symptoms
Response to treatment