Polymyalgia Rheumatica

Question 1

What is polymyalgia rheumatica?

Answer 1

An inflammatory condition that causes pain and stiffness in the shoulders, pelvic girdle, and neck

It is associated with giant cell arteritis and is most common in older, white patients.

Question 2

What are the core symptoms of polymyalgia rheumatica?

Answer 2

Pain and stiffness of the shoulders, pelvic girdle, and neck

Symptoms may have a relatively rapid onset.

Question 3

What are the characteristics of pain and stiffness in polymyalgia rheumatica?

Answer 3

• Worse in the morning
• Worse after rest or inactivity
• Interferes with sleep
• Takes at least 45 mins to ease in the morning
• Somewhat improves with activity

These characteristics help in the diagnosis of the condition.

Question 4

What associated symptoms may occur with polymyalgia rheumatica?

Answer 4

• Systemics (e.g. weight loss, fatigue)
• Muscle tenderness
• Carpal tunnel syndrome
• Peripheral oedema

These symptoms can provide additional context for diagnosis.

Question 5

List some differential diagnoses for polymyalgia rheumatica.

Answer 5

• Osteoarthritis
• Rheumatoid arthritis
• Systemic lupus erythematosus
• Statin-induced myopathy
• Myositis (e.g. polymyositis)
• Cervical spondylitis
• Adhesive capsulitis (frozen shoulder)
• Hyperthyroidism or hypothyroidism
• Osteomalacia
• Fibromyalgia
• Lymphoma or leukaemia
• Myeloma

These conditions can mimic the symptoms of polymyalgia rheumatica.

Question 6

What is the basis for diagnosing polymyalgia rheumatica?

Answer 6

• Clinical presentation
• Response to steroids
• Excluding differentials

Inflammatory markers like ESR and CRP are usually raised but can be normal.

Question 7

What is the initial management strategy for polymyalgia rheumatica?

Answer 7

Trial of steroids, typically 15mg prednisolone daily

Follow up after 1 week to assess response.

Question 8

What should be considered for long-term management of polymyalgia rheumatica?

Answer 8

• Long-term steroids (typically 1-2 years)
• Reducing regime of prednisolone

Monitoring for side effects is crucial.

Question 9

What does the acronym ‘Don’t STOP’ refer to in the context of managing patients on long-term steroids?

Answer 9

• Don’t - steroid dependence risks if treatment is stopped abruptly
• S - sick day rules (increase dose if unwell)
• T - treatment card should be carried
• O - osteoporosis prevention (e.g. bisphosphonates, calcium, vitamin D)
• P - proton pump inhibitor for gastro-protection

This acronym serves as a guideline for safe steroid management.