Polymyalgia rheumatica

Question 1

What is myalgia?

Answer 1

Muscle pain

Question 2

What is polymyalgia rheumatica?

Answer 2

This is a relatively common (1%) chronic inflammatory condition of unknown cause, that affects elderly individuals

Question 3

Who is most at risk of polymyalgia rheumatica?

Answer 3

Those over 50
Those in Northern regions

Question 4

What condition is closely associated with polymyalgia rheumatica?

Answer 4

There is an association with giant cell arteritis or temporal arteritis, with approximately 15% of patients with PMR developing GCA and 40-50% of GCA patients developing PMR

Question 5

What are some symptoms of polymyalgia rheumatica?

Answer 5

• Symmetrical ache in shoulder, neck or hips that is relived by movement and usually disturbs sleep
• Extreme morning stiffness
• Fatigue
• Anorexia
• Weight loss
• Fever

Question 6

What are some clinical signs of polymyalgia?

Answer 6

Reduced ROM of shoulder neck and movement
Passive movement maintained
Muscle strength normal
Possible upper arm tenderness, pitting oedema and carpal tunnel syndrome

Question 7

What testing is usually required in polymylagia rheumatica?

Answer 7

Clinical examination (Usually all that’s required)
Blood testing (ESR, PV, CRP raised)
Temporal artery biopsy
Temporal artery USS

Question 8

How is polymyalgia rheumatica usually managed?

Answer 8

Polymyalgia rheumatica patients will often have a rapid and dramatic response to low dose steroids:

• PMR - Prednisolone 15mg daily
• GCA - Prednisolone 40-60mg daily
• Gradual reduction in steroid dose over 18 months to 2 years

There should be a gradual reduction in steroid dose over 18-24 months, by the end of which, the condition will have resolved in the majority of cases

Question 9

What are the Don’tSTOP rules of long term steroid usage?

Answer 9

Don’t - Stopping steroids abruptly after more than 3 weeks of usage risks adrenal crisis

S - Sick - Steroid usage may need to be increased n the patient becomes unwell

T - Treatment card - Patients should carry a steroid treatment card to alert others that they are steroid dependant

O - Osteoporosis - Patients may require bisphosphonates, calcium and vitamin D

P - PPI - PPIs may be required for gastro-protection