Polymyalgia Rheumatica Flashcards
What is polymyalgia rheumatica (PMR)?
(1) A chronic inflammatory condition affecting muscles around the shoulders, neck, and hips
(2) Seen in patients >50 years
(3) Often associated with giant cell arteritis
Who gets polymyalgia rheumatica (PMR)?
Women >50 years, especially northern European
What key condition is PMR associated with?
Giant cell arteritis
What are the hallmark symptoms of Polymyalgia Rheumatica?
- Bilateral shoulder + Hip girdle pain
- Morning stiffness >45 mins
- No true weakness
What systemic symptoms are seen in Polymyalgia Rheumatica?
Fatigue, low-grade fever, weight loss, anorexia
What is a key clinical finding on examination in those with Polymyalgia Rheumatica?
Normal muscle strength despite pain and stiffness
What blood marker is usually raised in PMR?
ESR + CRP
= Often very high
What is CK in PMR?
Normal — helps differentiate from polymyositis
What is the first-line treatment for PMR?
- Prednisolone 15mg daily
- Tapered gradually over 18 months - 2 years
- With a dramatic response to steroids
What if PMR has an organ-threatening disease, what should you give?
Steroids + cyclophosphamide
If a patient over 60 develops new-onset diabetes mellitus along with weight loss, what diagnosis should you consider?
Pancreatic Cancer
A 63-year-old gentleman attends the GP following a month’s pain in his hips and shoulders. He finds he has stiffness in his shoulders that improves after an hour of waking. He has had neck pain since last week.
What condition is most commonly associated with the condition described above?
Giant cell arteritis
A 67-year-old woman presents with a few days’ history of pain and stiffness in her shoulders and upper arms. She used to be independent with her activities of daily living (ADLs). However, she has been struggling with dressing, bathing and cooking as her movements of the upper arms are limited by pain. There are mild crepitations on the passive movement of her shoulders and active movement is limited by pain in the muscles. She is denying any ocular or dermatological symptoms. She is not on any medications.
What investigation is essential in confirming the most likely diagnosis?
ESR
An 85-year-old woman presents to the GP with a six-week history of pain and early morning stiffness in the shoulders and hips. She was diagnosed with polymyalgia rheumatica and started on steroids.
What further scan should the GP consider doing?
DEXA SCAN - assess fracture risk
A 70-year-old woman complains of severe bilateral shoulder and hip girdle pain and stiffness for the past 2 weeks.
Given the most likely diagnosis, which blood test is most likely to be elevated?
ESR
A 60-year-old woman presents to the GP with bilateral shoulder pain that worsens in the morning. Suspecting polymyalgia rheumatica (PMR), she is commenced on prednisolone 15 mg. After 3 weeks, there is no improvement in her symptoms.
What is the most appropriate next step? and why
Stop steroids and consider an alternative diagnosis
= Patients with polymyalgia rheumatica typically respond dramatically to steroids
Always consider another diagnosis in these situations!!!!
