Polymyalgia Rheumatica

Question 1

Define PMR

Answer 1

Polymyalgia rheumatica (PMR) is an inflammatory rheumatological syndrome that manifests as pain and morning stiffness involving the neck, shoulder girdle, and/or pelvic girdle in individuals older than 50 years.

PMR occurs either as an isolated condition or associated with giant cell arteritis.

Question 2

Explain the aetiology / risk factors of polymyalgia rheumatica

Answer 2

• Age over 50
• Female
• Giant Cell Arteritis

Question 3

Summarise the epidemiology of polymyalgia rheumatica

Answer 3

• Mainly occurs in white women over 50

Question 4

Recognise the presenting symptoms of polymyalgia rheumatica

Answer 4

• BILATERAL Shoulder and/or hip girdle
  
  • pain - worse with movement and interferes with sleep
  • morning stiffness
  • The patient may complain of:
    
    • Inability to get out of bed withoit help
    • Inability to comb hair/dress
    • gg
• Systemic Sx:
  
  • Fever
  • Weight loss
  • Malaise
• Sx persist for more than 2 weeks

Question 5

Recognise the signs of polymyalgia rheumaticaon physical examination

Answer 5

• Restricted range of motion at hips and shoulders: unable to move hands above head
• Tenderness at hip/shoulder

Question 6

Identify appropriate investigations for polymyalgia rheumatica and interpret the results

Answer 6

• Rapid response to steroids (prednisolone)
• ESR & CRP elevated
• Ultrasound: may show bursitis and joint effusion

Question 7

Generate a management plan for PMR

Answer 7

The goal of treatment is to establish an inflammation-free and symptom-free state. The patient should ideally return to the prior baseline level of function with a normal ESR and/or CRP.

• Low-dose prednisolone (response usually occurs in 24-74 hrs)
• Bone protection: alendronate, Ca and Vit-D
  
  • For all patients < 65, they should have their A T-score is an indicator to offer bone protection. If older, offer alendronate immediately
• Gastric protection: PPI

Question 8

Identify the possible complications of polymyalgia rheumatica and its management

Answer 8

• Chronic relapsing PMR
• Giant cell arteritis
• Complications of steroid use:
  
  • Increased risk of infection
  • Osteoporosis
  • Diabetes Mellitus
  • Muscle weakness

Question 9

Summarise the prognosis for patients with polymyalgia rheumatica

Answer 9

• The overall prognosis is good.
• Although response to treatment typically occurs within 24 to 72 hours, relapses or symptom exacerbations are common.