Polymyalgia Rheumatica Flashcards
What is polymyalgia rheumatica?
Inflammatory condition that causes pain & stiffness in the shoulders, pelvic girdle and neck
What does polymyalgia usually occur with?
Giant cell arteritis
Who does polymyalgia rheumatica usually occur in?
- Older adults
- Women
- Caucasians
Presnetation of polymyalgia rheumatica?
- Bilateral shoulder pain, may radiate to elbow
- Bilateral pelvic girdle pain
- Worse with movement
- Interferes with sleep
- Stiffness for less than 45 mins in morning
How long should symptoms persist for before diagnosing polymyalgia rheumatica?
-2 weeks or more
Other symptoms of polymyalgia rheumatica?
Systemic symptoms
Upper arm tenderness
Carpal tunnel syndrome
Pitting oedema
Differentials for polymyalgia rheumatica?
- Osteoarthritis
- RA
- SLE
- Myositis
- Cervical spondylosis
- Adhesive capsulitis of shoulder
- Hyper/hypo thyroidism
- Osteomalacia
- Fibromyalgia
Diagnosis of polymyalgia rheumatica?
Clinically based and also based on response to roids
Other investigations for diagnosis of polymyalgia rheumatica?
- Inflammatory markers (ESR, plasma viscosity, CRP)
- FBC
- U & Es
- Liver FTs
- Creatinine kinase
- Serum protein electrophoresis
- Thyroid stimulating hormone
- RF
- Urine dipstick
Additional investigations?
- ANA (SLE)
- Anti- CCP (RA)
- Urine Bence Jones protein (myeloma)
- Chest X-ray
Treatment of polymyalgia rheumatica?
STEROIDS
Process of treating with steroids?
Initial: start on 15mg of prednisolone per day
|
Asses after a week: if poor response in symptoms probably not PM so stop roids
|
Assess after 3-4 weeks: should have 70% improvement i in symptoms and inflammatory markers
|
If good response reduce regime
Process of reducing steroid regime?
15mg a day until symptoms fully controlled | 12.5mg for 3 weeks | 10mg for 4-6 weeks | Reduce 1,g every 4-8 weeks
Duration of treatmnet?
Can take 1-2 years to cure
Additional steps in tretament?
Use DON’T STOP pneumonic
