Polymyalgia Rheumatica

Question 1

What is polymyalgia rheumatica?

Answer 1

Inflammatory condition of unknown cause

Question 2

What is polymyalgia rheumatica associated with?

Answer 2

Temporal arteritis (giant cell arteritis)

Question 3

Who does polymyalgia rheumatic normally affect?

Answer 3

Older people

Question 4

What parts of the body does polymyalgia rheumatica affect?

Answer 4

Shoulders
Pelvic girdle
Neck

Question 5

How does polymyalgia rheumatica present?

Answer 5

• 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

Question 6

Where does the shoulder pain radiate in polymyalgia rheumatica?

Answer 6

To the elbows

Question 7

How long does morning stiffness last with polymyalgia rheumatica?

Answer 7

Up to 45 minutes

Question 8

What makes polymyalgia rheumatica worse?

Answer 8

Movement

Question 9

What can polymyalgia rheumatica disrupt?

Answer 9

Sleep

Question 10

What 2 other syndromes can present with polymyalgia rheumatica?

Answer 10

Carpal Tunnel syndrome

Pitting oedema

Question 11

How is polymyalgia rheumatic diagnosed?

Answer 11

Raised ESR and CRP more than 60mm/hr

Question 12

What do you need to exclude before diagnosing polymyalgia rheumatica?

Answer 12

Rheumatoid arthritis

Systemic Lupus erythematosus

Question 13

What should there not be in terms of movement with polymyalgia rheumatica?

Answer 13

True weakness

Normal power with resisted movements

Question 14

What is the management of polymyalgia rheumatica?

Answer 14

15mg Prednisolone

Question 15

When would you start to consider a differential diagnosis?

Answer 15

No improvement of condition after a week of steroids

Question 16

What are the typical features of polymyalgia rheumatica?

Answer 16

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

Question 17

What would not be present with polymyalgia rheumatica?

Answer 17

No joint swelling
No muscle wasting
No weakness

Question 18

When would you start to reduce the steroid regime?

Answer 18

After 3-4 weeks if there has been a good response

Question 19

What does “Don’t STOP” stand for?

Answer 19

Don’t
S- Sick day rule
T- Treatment card
O-Osteoporosis prevention
P- Proton pump inhibitor

Question 20

What does the don’t part state?

Answer 20

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

Question 21

What is the risk of abruptly withdrawing from steroids?

Answer 21

Adrenal crisis

Question 22

What are the sick day rules?

Answer 22

Increasing the steroid dose if they become unwell

Question 23

What is a treatment card for?

Answer 23

Provide a steroid treatment card to alert others that they are steroid dependent in case they become unresponsive

Question 24

What can be used for osteoporosis prevention?

Answer 24

Consider osteoporosis prophylaxis whilst on steroids with bisphosphonates and calcium and vitamin D supplements

Question 25

Why might you give a PPI to someone one steroids?

Answer 25

Gastric protection