Polymyalgia rheumatica

Question 1

Define polymyalgia rheumatica

Answer 1

• characterized by pain and stiffness of the proximal extremities (girdle area)
• closely related to giant cell arteritis (15% of patients with PMR develop GCA)
• no muscle weakness

Question 2

Who gets polymyalgia rheumatica?

Answer 2

• incidence 50 per 100,000 per year in those over age 50

* age of onset typically >50, F:M = 2:1

Question 3

Px of polymyalgia rheumatica

Answer 3

• constitutional symptoms prominent (fever, weight loss, malaise)
• pain and stiffness of symmetrical proximal muscles (neck, shoulder and hip girdles, thighs)
• gel phenomenon (stiffness after prolonged inactivity)
• physical examination reveals tender muscles, but no weakness or atrophy

Question 4

Ix of polymyalgia rheumatica

Answer 4

• bloodwork: often shows anemia, elevated platelets, elevated ESR and CRP; normal CK up to 5%
of PMR reported with normal inflammatory markers

Question 5

Rx of polymyalgia rheumatica

Answer 5

• goal of therapy: symptom relief
• start with prednisone dose of 15-20 mg PO once daily
• taper slowly over 2-yr period monitoring ESR and symptoms closely
• treat relapses aggressively (50% relapse rate)
• monitor for steroid side effects, glucocorticoid-induced osteoporosis prevention, follow for symptoms of giant cell arteritis