Polymyalgia Rheumatica Flashcards
1
Q
What is polymyalgia rheumatica?
A
- Clinical syndrome characterised by pain and stiffness of the shoulder, hip girdles and neck - proximal
- Primarily effects elderly
- Associated with morning stiffness and increased inflammatory markers
2
Q
Who is affected?
A
- Increase incidence with age
- Average onset is 70
- Rare in those under 50
- Peak is 70-80
- Associated with GCA
3
Q
Symptoms of PR
A
- New sudden onset of proximal limb pain and stiffness (neck, shoulder, hips) in elderly
- Difficulty rising from chair/combing hair (proximal muscles involved)
- Systemic symptoms - fatigue, weight loss, low grade fever
4
Q
Phsyical exam for PR
A
- Decreased ROM of shoulders, neck and hips
- Muscle strength normal - can be limited by pain/stiffness
- Muscle tenderness
5
Q
Diagnosing PR
A
- History
- Raised inflammatory markers
- ESR or PV as well as CRP
- Consider temporal artery biopsy if symptoms of GCA
6
Q
Treatment for PR
A
- Dramatic response within 5 days of starting prednisolone
- 15mg Prednisolone daily
- Taper down slowly
- Methotrexate can be steroid sparing in relapsing pts
7
Q
What is uncommon to have with inflammatory markers?
A
Uncommon for them to be normal - often raised
8
Q
What to do if not rapid response to steroids?
A
- Consider different diagnosis
9
Q
Adjust steroids re:
A
SYMPTOMS - NOT ESR/CRP
10
Q
Most common treatment length
A
18 months of prednisolone
11
Q
What tends to cause the pain in polymyalgia rheumatica?
A
Bursitis and tendonopathy
12
Q
Side effects steroids
A
- Osteoporosis
- Weight gain
- Hyperglycaemia
- Thinning skin
- Immunosupression
- Hypertension
- Proximal myopathy - treatment for something else can cause PMR like symptoms, treating with steroids won’t help
13
Q
Investigations in PMR
A
- Normocytic anaemia
- CK normal
- Raised ESR and CRP
- USS shows bursitis or tenosynovitis
14
Q
How long on steroids?
A
Try to wean down but when stop steroids can come back
Some people on low dose for very long time
Increase risk of risk factors
15
Q
A
