polymyalgia rheumatica

Question 1

what is it?

Answer 1

common chronic inflammatory condition affecting the elderly

Question 2

where does this inflammation usually occur?

Answer 2

muscles around the shoulders, neck and hips

Question 3

who does it affect?

Answer 3

ONLY women over 50

Question 4

what is it associated with?

Answer 4

giant cell arteritis

Question 5

which antibody is associated?

Answer 5

HLA DR4

Question 6

what is the pathophysiology?

Answer 6

immune cells directly attack endothelium
transmural - all layers are affected

Question 7

what are the symptoms?

Answer 7

morning stiffness lasting 45 mins
fatigue, anorexia, weight loss, fever
strength is normal

Question 8

what are the signs?

Answer 8

reduced movement of shoulders, neck and hips (unable to put hands behind back)
normal muscle strength
carpal tunnel
pitting oedema

Question 9

what is seen if renal artery is involved?

Answer 9

hypertension

Question 10

how is it diagnosed?

Answer 10

mainly clinically

Question 11

what investigations can be used?

Answer 11

bloods
biopsy
angiogram

Question 12

what will be seen on bloods?

Answer 12

raised inflammatory markers - ESR

Question 13

how is it differentially diagnosed from polymyositis?

Answer 13

creatine kinase is normal in this but raised in polymyositis

Question 14

what is the management?

Answer 14

prednisolone - usually resolve by end of course

Question 15

what is the management of non organ threatening disease?

Answer 15

steroids + azathioprine/methotrexate

Question 16

what is the treatment of organ threatening disease?

Answer 16

steroids + cyclophosphamamide

Question 17

what to do in recurrent illness if co-existing disease is present and corticosteroid has been tapered?

Answer 17

double dose of corticosteroid