Polymyalgia Rheumatica

Question 1

What is polymyalgia rheumatica?

Answer 1

Inflammatory condition which has strong association with giant cell arteritis i.e. both tend to occur together

Question 2

How might someone with polymyalgia rheumatica present?

Answer 2

> 50
F>M
More common in caucasians

Following symptoms lasting >2 weeks

• bilateral shoulder pain which can radiate to elbow
• bilateral pelvic girdle pin
• neck pain
• symtpoms worse on movement
• inteferes with sleep
• morning stiffness >45 mins

Additional symptoms:

• weight loss
• fatigue
• low grade fever
• low mood
• upper arm tenderness
• carpel tunnel syndrome
• pitting oedema

Question 3

What are important differentials to exclude before PMR is reached as diagnosis?
How is PMR diagnosed?

Answer 3

OA
RA
SLE
Myositis 
Cervical spondylosis 
Osteomalacia 
Fibromyalgia 

Clincial presentation + response to steroids

Question 4

What investigations should be done with polymyalgia rheumatica is suspected?

Answer 4

FBC
U+E
LFT
Calcium= osteomalacia or hyperparathyroidism 
Serum protein electrophoresis i.e myeloma or other protien disorders 
TFT- TSH for thyroid function 
Creatinien kinase= myositis 
RF 
Urine dipstick 
ANA= SLE
Anti-CPP= RA
Urine benice jones= myeloma 
CXR= lung + medistinal abnormalities

Question 5

How is PMR managed?

Answer 5

Steroids-> started on 15 mgs

-start to reduce the dose down gradually after 3-4 weeks if there is good response

Question 6

How do you need to be aware off when using long term steorids?

Answer 6

Don’t STOP

DON”T= need to advice patients that will be dependent after 3 weeks so need to come off steroids slowly rather than suddenly stopping to prevent adrenal crisis

S= sick day rules (increased dose when ill)

T= treatment card ( so people aware dependent on steroids if found unresponsive)

O= osteoporosis prevent = bisphosphonate w/ calcium + vit D supplementaion

P= PPI cover due to increase risk of gastric ulcer with NSAIDs