Polymyalgia Rheumatica

Question 1

Definition:

Answer 1

Inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders and hips.
The condition is related to another inflammatory condition called giant cell arteritis (inflammation of the lining of your arteries)

Question 2

Epidemiology:

Answer 2

Most people are older than 65

Rarely affects people under the age of 50

More common in women

More common in caucasians

Question 3

Aetiology

Answer 3

The exact cause is unknown. 2 factors appear to be involved in the development of the condition through:

Genetics- certain and gene varieties might increase your susceptibility

An environmental exposure- new cases of polymyalgia rheumatic tend t come in cycles, possible developing seasonally. This suggests that an environmental trigger, such as a virus, might play a role.

Question 4

Clinical Presentation

Answer 4

The signs and symptoms of PMR usually occur on both sides of the body and might include:
– aches or pain in shoulders
– aches or pain in neck, upper arms, buttocks, hips or thighs
– stiffness in affected areas, particularly in the morning or after being inactive for a time
– limited range of motion in affected areas
– pain worse with movement
– interferes with sleep
– stiffness in morning, lasting longer than 30 minutes

You may also have more-general signs and symptoms:
– mild fever
– fatigue
– loss of appetite
– depression
– pitting oedema

Question 5

Investigations

Answer 5

Blood tests- indicators of inflammation:
– raised ESR (erythrocyte sedimentation rate)
– Raised CRP (C-reactive protein)
– increased plasma viscosity
If these are all still normal, it still doesn’t rule out PMR

Imaging tests:
– ultrasound is being used to distinguish PMR from other conditions that cause similar symptoms

Additional investigations:
– ANA test (antinuclear antibodies)- test for systemic lupus erythematosus
– Anti-CCP- test for RA
– Urine bence jones- test for myeloma
– chest x-ray to look for lung pathologies

Question 6

Treatment

Answer 6

Steroids:
– Both PMR and GCA respond very well to treatment with steroids.
- initially 15mg prednisolone
- if there is a poor response about a week in, then it is probably not PMR
- 3-4 weeks- there should be 70% improvement and the inflammatory indicators back to normal- this will allow working diagnosis of PMR

Long term use of steroids can have side effects:
- weight gain
- loss of bone density
- high blood pressure
- diabetes
- cataracts

Physical therapy