Polymyalgia rheumatica

Question 1

What is it?

Answer 1

Polymyalgia rheumatic is an inflammatory rheumatological condition that presents with the abrupt onset of bilateral morning stiffness and pain (typically in the shoulders and/or hips and/or neck)

Question 2

What does it often occur with?

Answer 2

Giant Cell Arteritis

Question 3

Who is usually affected?

Answer 3

• Incidence increases with age.
• Average age of onset ~70 years
• Rare in people <50 years of age
• Peak incidence is between ages 70 and 80
• More common in females and caucasians

Question 4

Differentials of shoulder or hip pain?

Answer 4

• Adhesive capsulitis
• Osteoarthritis
• Rheumatoid arhtirits
• Systemic lupus erythematosus
• Osteomalacia
• Fibromyalgia

Question 5

Symptoms ?

Answer 5

• rapid onset (<1 month)
• morning stiffness and pain in proximal limb muscles (neck, shoulder and hips)
• Difficulty rising from chair or combing hair
  (proximal muscle involvement)
• Night time pain
• Systemic symptoms - 25%
  
  • weight loss
  • Fatigue
  • low-grade fever

Question 6

Signs on examination

Answer 6

• Decreased Range of movement (ROM) is limited by stiffness and pain in neck, shoulder, hips
• Muscle strength is preserved
• Muscle tenderness

Question 7

What investigations would you do ?

Answer 7

• raised inflammatory markers
  
  • ESR > 40 mm/hr
  • Plasma viscosity
  • CRP

Consider temporal artery biopsy if symptoms of GCA

notecreatine kinaseand EMG normal

Question 8

How is the diagnosis made?

Answer 8

Diagnosis made through history, examination and response to steroids which are supported by raised inflammatory markers

Question 9

management?

Answer 9

Dramatic response to treatment within 5 days of steroids (diagnostic)

• prednisolonee.g. 15mg/od
• most pts require 18 months of treatment with prednisolone
• It is then tapered very slowly, rapid taper associated with symptom relapse

Methotrexate- steroid-sparing in relapsing patients