Polymyalgia rheumatica

Question 1

Define polymyalgia rheumatica

Answer 1

Inflammatory condition of unknown cause, characterised by severe bilateral pain & morning stiffness of the shoulder, neck & pelvic girdle

Does NOT cause weakness

Question 2

Aetiology of polymyalgia rheumatica

2

Answer 2

UNKNOWN

Genetic & environmental factors

Question 3

Associations of polymyalgia rheumatica

1-3

Answer 3

Temporal arteritis
40-50% patients have polymyalgia rheumatica
15% w/ polymyalgia rheumatica develop temporal arteritis
Both conditions respond to corticosteroids

Question 4

Epidemiology of polymyalgia rheumatica

prevalence, age x2, gender

Answer 4

Relatively common
Occurs in people aged >50 yrs
Peak age of onset 73 yrs
3x more common in FEMALES

Question 5

Presenting symptoms & signs of polymyalgia rheumatica

general + 5

Answer 5

Tend to be relatively non specific

Bilateral shoulder pain & stiffness of acute or subacute onset w/ bilateral arm tenderness
NO WEAKNESS
Symptoms worse when walking
Morning stiffness may be so bad they find it difficult to get out of bed or raise their arms enough to brush their hair
May be flu like symptoms at onset

Question 6

Usual inclusion criteria for polymyalgia rheumatica

5

Answer 6

Age > 50 yrs
Duration of symptoms > 2 weeks
Bilateral shoulder or pelvic girdle aching or both
Morning stiffness lasting > 45 mins
High ESR/CRP

Question 7

Investigations for polymyalgia rheumatica

8

Answer 7

ESR/CRP - raised
FBC
U&Es
LFTs
Bone profile 
Protein electrophoresis
TFTs
Creatine kinase
Others: urinary Bence Jones proteins, autoantibodies (e.g. anti-CCP antibodies)

Question 8

Management of polymyalgia rheumatica

4

Answer 8

CORTICOSTEROIDS
Steroid sparing agents (e.g. methotrexate) sometimes used
Assistance from physiotherapy & occupational therapy
Monitor for adverse affects of steroids (e.g. osteoporosis)

Question 9

Complications of polymyalgia rheumatica

3

Answer 9

Temporal arteritis
Relapse of disease
Complications of steroid use (e.g. fracture risk)

Question 10

Prognosis of polymyalgia rheumatica

4

Answer 10

15% risk of getting temporal arteritis
Variable course & prognosis
Usually respond rapidly to steroid treatment
Relapse is common