Polymyalgia rheumatica

Question 1

Polymyalgia rheumatica

Answer 1

Inflammatory condition that causes pain and stiffness in shoulders, pelvic girdle and neck

More common in women

More common in caucasions

Question 2

Associations

Answer 2

Giant cell arteritis

Question 3

Features

Answer 3

Typically patient >60 years old

Usually rapid onset (<1 month)

Bilateral shoulder/ pelvic girdle pain worse with movement

Aching, morning stiffness in proximal limb muscles (at least 45 minutes in the morning)

Weakness is NOT a symptom

Mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats

Question 4

Differentials

Answer 4

Osteoarthritis

Rheumatoid arthritis

SLE

Myositis

Cervical spondylosis

Adhesive capsulitis of both shoulders

Osteomalacia

Fibromyalgia

Question 5

Investigations

Answer 5

Diagnosis mainly based on clinical presentation and the response to steroids

Inflammatory markers are usually raised

Creatine kinase and EMG normal

Question 6

Treatment

Answer 6

Prednisolone

Expected 70% improvement in symptoms and inflammatory markers to return to normal

Start a reducing regime after 3-4 weeks if good response

Question 7

Steroid rules

Answer 7

Make them aware that they will be steroid dependent and should not stop due to adrenal crisis risk

Sick day rules: increase dose if unwell

Treatment cards: to alert others if unresponsive

Osteoporosis prevention: bisphosphonates and calcium and vitamin D

PPI: consider gastric protection