Polymyalgia rheumatica

Question 1

Polymyalgia rheumatica is a condition that causes muscle pain and stiffness of the joints. What is the incidence of Polymyalgia rheumatica?

1 - 8.5 : 100,000
2 - 85 : 100,000
3 - 850 : 100,000
4 - 8500 : 100,000

Answer 1

2 - 85 : 100,000

Question 2

Is polymyalgia rheumatica or giant cell arteritis more common?

Answer 2

• polymyalgia rheumatica
• 3:1

Question 3

Polymyalgia rheumatica is a condition that causes muscle pain and stiffness of the joints. What is the mean age that Polymyalgia rheumatica affects?

1 - >40
2 - >50
3 - >60
4 - >70

Answer 3

4 - >70

Question 4

Is Polymyalgia rheumatica more common in men or women?

Answer 4

• women
• 3:1

Question 5

In a normal response, antigen presenting cells (APCs) typically engulf foreign pathogens and phagocytose them. Do they then present an antigen using class I or II MHC?

Answer 5

• MHC-II
• typically this would be a dendritic cell

MHC-I is self cell antigens

Question 6

Once an antigen presenting cell (APC) has engulfed and presented the antigen on its MHC-II, which cell binds with this?

1 - T helper cells
2 - B cells
3 - cytotoxic T cells
4 - other APCs

Answer 6

1 - T helper cells
- T cell becomes active and releases cytokines
- cytokine attract immune cells (macrophages) to area and inflammation follows

Question 7

In addition to T-helper cells secreting cytokines, macrophages, an APC are able to secrete cytokines that attract B cells that can then produce antibodies. These antibodies then attack self antigens by mistake.

Answer 7

Question 8

Although the exact cause of polymyalgia rheumatica is unknown genetic factors have been identified. All of the following have been associated with polymyalgia rheumatica. Which of the following has the strongest link?

1 - DRB1*01
2 - HLA-DRB1
3 - HLD-DR4
4 - all equally affected risk

Answer 8

3 - HLA-DR4
- some patients develop Polymyalgia rheumatica following infection with adenovirus

Question 9

Although the exact cause of polymyalgia rheumatica is unknown genetic factors have been identified. Is there. seasonal aspect of Polymyalgia rheumatica?

Answer 9

• yes
• associated with adenovirus, respiratory syncytial virus, which are more common in winter

Question 10

Which condition has been associated with polymyalgia rheumatica?

1 - RA
2 - Gout
3 - Pseudogout
4 - Giant cell arteritis

Answer 10

4 - Giant cell arteritis

Question 11

In Polymyalgia rheumatica are patients typically stiffer in the morning or evening?

Answer 11

• morning

Question 12

Polymyalgia rheumatica is associated with stiffness in the mornings. Typically how long does this last for?

1 - 10-15 minutes
2 - 20-30 minutes
3 - 45 mins - 1h
4 - >1h

Answer 12

3 - 45 mins - 1h

Question 13

Patients who present with polymyalgia rheumatica will typically present with acute symptoms that have been ongoing for how long?

1 - 2 days
2 - 2 weeks
3 - 2 months
4 - 2 years

Answer 13

2 - 2 weeks

Question 14

All of the following joints are typically affected in polymyalgia rheumatica, BUT which 2 are most commonly affected?

1 - neck
2 - shoulder
3 - hip
4 - torso

Answer 14

2 - shoulder
3 - hip

Question 15

In polymyalgia rheumatica, are the symptoms always unilateral?

Answer 15

• no
• start unilateral before progressing to bilateral

Question 16

Although the name polymyalgia rheumatica suggests that muscles and joints are affected, does biopsy typically show any changes in polymyalgia rheumatica?

Answer 16

• no
• joint lining is affected causing synovitis
• structures surrounding joint are affected such as tendons and bursae causing deferred pain in muscles

Question 17

In addition to deferred muscle pain and joint stiffness, which of the following systemic symptoms are present?

1 - malaise
2 - fatigue
3 - depression
4 - anorexia
5 - weight loss
6 - low grade fever
7 - all of the above

Answer 17

7 - all of the above

Question 18

When trying to diagnose patients with polymyalgia rheumatica, which 2 of the following are commonly elevated?

1 - RF
2 - ANA
3 - ESR
4 - CRP

Answer 18

3 - ESR
4 - CRP

Some studies say ESR is more specific, others say CRP is

Question 19

When trying to diagnose patients with polymyalgia rheumatica, do patients typically test positive or negative for RF, ANA and CCP?

Answer 19

• negative

Question 20

When trying to diagnose patients with polymyalgia rheumatica, what is the common finding on ultrasound and MRI?

1 - joint damage
2 - excess fluid in joint space
3 - crystals
4 - synovitis and bursitis

Answer 20

4 - synovitis and bursitis

Question 21

What is the 1st line treatment for a patient with polymyalgia rheumatica?

1 - immunosuppressives
2 - glucocorticoid
3 - NSAIDs
4 - colchicine

Answer 21

2 - glucocorticoid
- prednisolone is 1st line
- start at oral 15mg/day

Question 22

The 1st line treatment for a patient with polymyalgia rheumatica is 15mg/da oral dose of prednisolone. How long does it typically take patients to improve following prednisolone administration?

1 - 12h
2 - 24h
3 - 72h
4 - 96h

Answer 22

3 - 72h

Dose that suppresses symptoms should be maintained for two to four weeks and then gradually reduced