Chapter 44

Question 1

What raises suspicion for polymyalgia rheumatica (PMR)?

Answer 1

Chronic bilateral pain and stiffness in the shoulder neck pelvic girdle last over 30 minutes in a patient over 50 years old

Question 2

What are the possible differential diagnosis?

Answer 2

PMR, Rheumatoid arthritis, SLE, hypothyroidism, fibromyalgia, polymyositis, malignancy

Question 3

What is seen in physical examination for PMR patients?

Answer 3

Normal physical examination

Question 4

What diagnostic testing should be done for this patient?

Answer 4

CBC BMP CXR(check for malignancy), TSH, ESR/CRP, CPK, ANA, RF

Question 5

What are the positive findings for PMR?

Answer 5

Elevated ESR, normochromic normocytic anemia

Question 6

What is the definitive diagnostic test for PMR? Treatment?

Answer 6

Trial of corticosteroids

Question 7

What are the Criteria’s to clinically diagnosed PMR?

Answer 7

Bilateral pain and morning stiffness and. Age greater than 50
ESR greater than 40 or elevated CRP
Rapid response to steroids usually within three days

Question 8

What is the treatment for PMR?

Answer 8

Low-dose steroids for 2-4 weeks after symptom resolution. Then gradually tapered every 2-4 weeks to the lowest dose and maintain for 1-2year

Question 9

What should be done for osteoporosis prevention on this patient?

Answer 9

Calcium and vitamin D should be given along with baseline DEXA scan to assess for need for bisphosphonates

Question 10

What should be giving for prophylaxis in this patient? Why?

Answer 10

PPI (or H2 blocker or Misoprostol) for gastroduodenal protection

Question 11

What should be monitored in follow up?

Answer 11

ESR CRP CBC, screen for vasculitis especially giant cell arteritis (GCA)(temporal artery biopsy if suspected)