Polymyalgia Rheumatica Flashcards
What is polymyalgia rheumatica (PMR)?
It is defined as an immune-mediated inflammatory disorder of the proximal muscles
Which three regions of the body tend to be affected by polymyalgia rheumatica?
Neck
Shoulder
Pelvic Girdle
What five risk factors are associated with polymyalgia rheumatica?
Older Age > 50 Years Old
Female Gender
White Race
Family History
Giant Cell Arteritis
Are the clincial features of polymyalgia rheumatic unilateral or bilateral?
Bilateral
When do the clinical features of polymyalgia tend to present?
Acutely - over a period of 2 weeks
What are the nine clincial features of polymyalgia rheumatica?
Fatigue
Low Grade Fever
Proximal Muscle Aches
Proximal Muscle Morning Stiffness
Reduced Proximal Muscle Movement
Polyarthralgia
Depression
Weight Loss
Night Sweats
Which clincial feature is not associated with polymyalgia rheumatica?
Proximal Muscle Weakness
What four investigations are used to diagnose polymyalgia rheumatica?
Blood Tests
Ultrasound Scans
MRI Scans
Fluorodeoxyglucose F-18 Positron Emission Tomography (FDU PET)
Which three blood tests indicate polymyalgia rheumatica?
Increased ESR Levels > 40mm/hr
Increased CRP Levels
Normal Creatinine Kinase
What are the three features of polymyalgia rheumatica on ultrasound scans?
Joint Effusion
Synovitis
Bursitis
What are the two features of polymyalgia rheumatica on MRI scans?
Synovitis
Bursitis
What is the feature of polymyalgia rheumatica on FDU PET scans?
There is increased uptake within the bursa/synovium of the shoulders, ischial tuberosity and greater trochanters
What are the four diagnostic criteria of polymyalgia rheumatica?
Age > 50 Years Old
Morning Proximal Muscle Stiffness/Pain
Increased ESR/CRP Levels
Steroid Therapy Response
What is the gold standard management option of polymyalgia rheumatica?
Glucocorticoids
Name a glucocorticoid steroid used to manage polymyalgia rheumatica
Prednisolone
Describe the glucocorticoid regime used to manage polymyalgia rheumatica
It involves initial administration of 15mg of prednisolone per day, which is then tapered over a period of weeks to months as clinical features resolve and inflammatory markers improve
Why is a glucocorticoid tapering regime important in polymyalgia rheumatica?
A rapid withdrawal of steroids after long term use can result in Addisonian crisis
What is the glucocorticoid regime used in polymyalgia rheumatica?
The prednisolone 15mg once daily dose is administered until clinical features are fully controlled – usually 3 weeks
The prednisolone dose is then reduced to 12.5mg once daily for 3 weeks
The prednisolone dose is then reduced to 10mg once daily for 4 – 6 weeks
The prednisolone dose is then reduced by 1mg every 4 – 8 weeks until treatment is stopped
What are the three main side effects of chronic glucocorticoid steroid therapy?
Osteoporosis
Gastro-Oesophageal Reflux Disease
Hyperglycaemia
What should immediately be administered with glucocorticoid in order to prevent osteoporosis side effects?
Bisphosphonates
Calcium Supplements
Vitamin D Supplements
What should immediately be administered with glucocorticoid in order to prevent GORD side effects?
Proton Pump Inhibitors (PPIs)
What is the most appropriate management step when polymyalgia rheumatica doesn’t respond to prednisolone after one week?
There should be consideration of an alternative diagnosis – therefore we conduct specialist referral and stop steroid administration
