polymyalgia rheuamatica

Question 1

what

Answer 1

inflammatory condition causing pain and stiffness in shoulders, pelvic girdle and neck

Question 2

strong assoc w

Answer 2

giant cell arthritis

Question 3

more common in

Answer 3

> 50yrs
women
caucasians

Question 4

core features

Answer 4

should be >2wks

• bilateral shoulder pain
• bilateral pelvic girdle pain
• worse w movement
• interfers w sleep
• 45mins morning stiffness

Question 5

extra features

Answer 5

weight loss, fatigue, fever, low mood
carpal tunnel syndrome
pitting oedema

Question 6

differential diagnoses

Answer 6

OA
RA
SLE
myositis
cervical spondylosis
adhesive capsulitis
osteomalacia
fibromyalgia

Question 7

diagnosis based on

Answer 7

clinical presentation

response to steroids

Question 8

manage with

Answer 8

steroids - prednisolone

Question 9

steroid regime

Answer 9

1. start 15mg prednosolone per day
2. assess 1 wk - if poor response stop steroids and consider alt diagnosis
3. assess 3-4wks
4. if 3-4wms give good response start reducing regime

Question 10

steroid reducing regime

Answer 10

1. 15mg until symptoms fully controlled
2. 12.5mg 3wks
3. 10mg for 4-6wms
4. reduce by 1mg every 4-8wks

Question 11

additional measures for pt on long-term steroids: DONT

Answer 11

they will become steroid dependant after 3wks

should not stop taking them due to risk of adrenal crisis if steroids abruptly withdrawn

Question 12

additional measures for pt on long-term steroids: STOP

Answer 12

S- sick day rules (increase dose if unwell)
T: treatment card
O: osteoporosis prophylaxis
P: PPI