Polymyalgia Rheumatica

Question 1

Epidemiology of PMR

Answer 1

adults >55, F:M 2:1,
The incidence of the disease in patients aged over 50 is about 100 per 100,000.
occurs almost exclusively in people aged above 50, and the mean age of onset is about 73, most commonly 60-80 yrs
Seen mainly in people of north European ancestry

Question 2

aetiology of PMR

Answer 2

unknown causes
inflammation in the blood
Develops in 40-60% cases of giant cell arteritis
(genetic enviromental factors)

Question 3

Pathogenesis of PMR

Answer 3

unknown

Question 4

Clinical manifestations of PMR

Answer 4

Bilateral constant aching of the shoulder girdle and hip girdle muscles, also experienced in back and neck muscles.
morning stiffness > 45mins

Question 5

Symptoms of PMR

Answer 5

pain worse in AM, sometimes preventing patient from getting up.
subacromial bursitis, bicipital tenosynovitis.

May have systemic presentation with fever, weight loss, depression, malaise

Wrist and knee synovitiis
Nocturnal Pain
Oedema of hands, wrists, ankles and feet.
Carpal tunnel syndrome

Question 6

Physical Signs

Answer 6

Pain on active and passive movement of joints (shoulders 70-95%, hips and neck 50-70%).
Morning stiffness; stiffness after periods of rest and morning stiffness of more than one hour are typical.
Systemic symptoms, especially present at the onset of the disease; these include lethargy, loss of appetite, weight loss, low-grade fever and depression.
Mild asymmetrical synovitis - may occur, especially in the wrists and knees.
Oedema of hands, wrists, ankles and feet.
Carpal tunnel syndrome

Question 7

complications

Answer 7

1/3 develop giant cell arteritis

s/e of long term steroid use.

Question 8

prognosis

Answer 8

good if treated with corticosteroids