Polymyalgia Rheumatica Flashcards
What is polymyalgia rheumatica?
Inflammatory condition of unknown cause
What is polymyalgia rheumatica associated with?
Temporal arteritis (giant cell arteritis)
Who does polymyalgia rheumatic normally affect?
Older people
What parts of the body does polymyalgia rheumatica affect?
Shoulders
Pelvic girdle
Neck
How does polymyalgia rheumatica present?
- Bilateral shoulder pain- radiates to elbow
- Bilateral pelvic girdle pain
- Worse with movement
- Interrupts sleep
- Morning stiffness up to 45mins in the morning-synovitis
- Carpal tunnel syndrome
- Pitting oedema
Where does the shoulder pain radiate in polymyalgia rheumatica?
To the elbows
How long does morning stiffness last with polymyalgia rheumatica?
Up to 45 minutes
What makes polymyalgia rheumatica worse?
Movement
What can polymyalgia rheumatica disrupt?
Sleep
What 2 other syndromes can present with polymyalgia rheumatica?
Carpal Tunnel syndrome
Pitting oedema
How is polymyalgia rheumatic diagnosed?
Raised ESR and CRP more than 60mm/hr
What do you need to exclude before diagnosing polymyalgia rheumatica?
Rheumatoid arthritis
Systemic Lupus erythematosus
What should there not be in terms of movement with polymyalgia rheumatica?
True weakness
Normal power with resisted movements
What is the management of polymyalgia rheumatica?
15mg Prednisolone
When would you start to consider a differential diagnosis?
No improvement of condition after a week of steroids
What are the typical features of polymyalgia rheumatica?
typically patient > 60 years old
usually rapid onset (e.g. < 1 month)
Aching, morning stiffness in proximal limb muscles
No weakness
Mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats
What would not be present with polymyalgia rheumatica?
No joint swelling
No muscle wasting
No weakness
When would you start to reduce the steroid regime?
After 3-4 weeks if there has been a good response
What does “Don’t STOP” stand for?
Don’t
S- Sick day rule
T- Treatment card
O-Osteoporosis prevention
P- Proton pump inhibitor
What does the don’t part state?
DON’T – Make them aware that they will become steroid dependent after 3 weeks of treatment and should not stop taking the steroids due to the risk of adrenal crisis if steroids are abruptly withdrawn
What is the risk of abruptly withdrawing from steroids?
Adrenal crisis
What are the sick day rules?
Increasing the steroid dose if they become unwell
What is a treatment card for?
Provide a steroid treatment card to alert others that they are steroid dependent in case they become unresponsive
What can be used for osteoporosis prevention?
Consider osteoporosis prophylaxis whilst on steroids with bisphosphonates and calcium and vitamin D supplements
Why might you give a PPI to someone one steroids?
Gastric protection
