Polymyalgia Rheumatica

Question 1

Polymyalgia Rheumatica : Definition

Answer 1

1. immune mediated rheumatic condition affecting joints, sparing muscles
2. Polymyalgia rheumatica (PMR) is an inflammatory condition that causes pain and stiffness in the shoulders, pelvic girdle and neck.
3. There is a strong association with giant cell arteritis, and the two conditions often occur together.

Question 2

Polymyalgia Rheumatica : Incidence

Answer 2

1. Most common in elderly white females
2. Strongly associated with Giant cell arteritis
3. Associated with gene HLA-DR4

Question 3

Polymyalgia Rheumatica : Clinical features

Answer 3

• Rapid onset < 1 month
• Symptoms must be present for 2 weeks

1. Joint involvement
   * shoulder, hip joints, and neck
   * starts unilaterally and progresses bilaterally within a few weeks
2. Pain and stiffness of joint
   Activity
   * More severe after prolonged inactivity/rest e.g. morning
   * Improves with activity

Associated symptoms
Affects nearby nerves in muscles - referred pain
1. Temporal arteritis : jaw pain, vision problems, severe headache
2 .Systemic symptoms : Low grade fever, fatigue,weight loss, loss of appetite

Question 4

Polymyalgia Rheumatica : Diagnosis

Answer 4

Diagnosis is based on clinical presentation, response to steroidsand excluding differentials.

1. Blood tests: Raised inflammatory markers (ESR and CRP elevated),
2. Antibody serology to r/o other systemic disease
   * ANA for SLE, anti-CCP for RA

3 . Biopsy shows inflammation in joints
Physical exam : reduced passive ROM of affected joints

Question 5

Polymyalgia Rheumatica : Management

Answer 5

Mx : Low dose corticosteroids e.g. 15mg Prednisolone