Polymyalgia Rheumatica

Question 1

What is polymyalgia rheumatica?

Answer 1

chronic, systemic rheumatic inflammatory disease characterized by aching and morning stiffness in the neck, shoulder, and pelvic girdle.

Question 2

What is the aetiology of PMR?

Answer 2

Unknown

Might be an early manifestation of vasculitis with articular inflammatory process

• HLA DR4 predisposes
• Can be triggered by Adenovirus and Parvovirus B19

Question 3

What are risk factors for the development of PMR?

Answer 3

Female

>50

GCA

Question 4

What are the symptoms of PMR?

Answer 4

• Rapid onset (<1month)
• Bilaterial Pain in proximal limbs (shoulder girdle/Neck/ pelvic girdle)
  
  • Especially at night
  • Morning stiffness (>60min)
  • Gets better with movement
• Additional symptoms:
  
  • Low grade fever
  • Fatigue
  • Anorexia
  • Weight loss
  • Depression

Question 5

What is the prevalence of PMR?

Answer 5

2nd most common rheumatoid disease (after RA)

0.85%

Question 6

What are the complications of PMR?

Answer 6

1. Giant Cell Arteritis and associated complications
2. Long-term steroid use complications

Question 7

Which investigations would you order in someone with suspected Polymyalgia Rheumatica?

Answer 7

• Clinical presentation
• Response to treatment (oral prednisolone)
  
  • Fast response
  • Try to slowly stop after 1-2 years
• Bloods
  
  • FBC, U%E, Liver, TSH, Calcum ALP. RF
  • ESR+ (+ CRP might also be high)
  • CK not elevated ( do to exclude other muscular reasons)
• Exclusion of other conditions
  
  • (e.g. malignancy

Question 8

How do you manage PMR?

Answer 8

• Education
• High dose Prednisolone (15mg/day)
  
  • Try to wind down wirthin 1-2 years, first reduction after 4 weeks
• With osteoprotection
  
  • DEXA scan
  • Bisphosphonates and Vit D
• Screen for Giant Cell arteritis