Polymyalgia Rheumatica

Question 1

Definition

Answer 1

Inflammatory condition that causes pain and stiffness in the shoulders, pelvic girdle, and neck

Question 2

Epidemiology

Answer 2

Older white patients

Question 3

Signs and symptoms

Answer 3

Rapid onset of symptoms over days to weeks = Pain and stiffness of the:
- Shoulders potentially radiating to the upper arm and elbow
- Pelvic girdle potentially radiating to the thighs
- Neck

Question 4

Signs and symptoms

Answer 4

Rapid onset of symptoms over days to weeks = Pain and stiffness of the:
- Shoulders potentially radiating to the upper arm and elbow
- Pelvic girdle potentially radiating to the thighs
- Neck

Question 5

Characteristics of pain and stiffness

Answer 5

• Worse in the morning
• Worse after rest or inactivity
• Interfere with sleep
• Take at least 45 minutes to ease in the morning
• Somewhat improve with activity

Question 6

Assosciated features

Answer 6

Systemic symptoms (e.g., weight loss, fatigue and low-grade fever)
Muscle tenderness
Carpel tunnel syndrome
Peripheral oedema

Question 7

Diagnosis

Answer 7

Clinical diagnosis

Question 8

Treatment

Answer 8

15mg prednisolone = daily initially
Patients will have a dramatic improvement within one week.
Reduction regime:
15mg until the symptoms are fully controlled, then
12.5mg for 3 weeks, then
10mg for 4-6 weeks, then
Reducing by 1mg every 4-8 weeks