Polymyalgia Rheumatica

Question 1

What is polymyalgia rheumatica?

Answer 1

It is an inflammatory condition that causes pain and stiffness in the shoulders, pelvic girdle and neck

Question 2

What condition does PMR often occur with?

Answer 2

Giant cell arteritis

Question 3

What is the presentation of PMR?

Answer 3

Symptoms should persist for 2 weeks - Pain and stiffness of:
- Shoulders
- Pelvic girdle
- Neck

May be associated with:
- Systemic symptoms
- Muscle tenderness
- Carpal tunnel syndrome
- Peripheral oedema

Question 4

What are the characteristics of the pain and stiffness in PMR?

Answer 4

Worse in the morning
Worse after rest
Interferes with sleep
Takes at least 45 mins to ease in the morning
Somewhat improves with activity

Question 5

What are the differentials of PMR?

Answer 5

Osteoarthritis
Rheumatoid arthritis
SLE
Statin-induced myopathy
Polymyositis
Adhesive capsulitis
Cervical spondylysis
Myeloma
Osteomalacia
Fibromyalgia

Question 6

What investigations are used to help with diagnosis of PMR?

Answer 6

CRP/ESR - RAISED

FBC
U&E
LFT
Calcium
Serum protein electrophoresis - myeloma
TFTs
Creatinine kinase - myositis (creatinine kinase is normal in PMR)
Rheumatoid factor - rheumatoid arthritis
Urine dipstick

Question 7

What is the treatment of PMR?

Answer 7

15mg predisolone daily (typically for 1-2 years, but patients normally respond dramatically to steroids)