Polymyalgia Rheumatica

Question 1

What is Polymyalgia Rheumatica?

Answer 1

Inflammatory condition affecting shoulders and pelvic girdle

***Synovium and bursa

Question 2

What is Polymyalgia Rheumatica associated with?

Answer 2

HLA-DR4

Question 3

What does HLA-DR4 contribute to?

Answer 3

Actives immune system leading to inflammation

Question 4

What are the clinical manifestations of Polymyalgia Rheumatica?

Answer 4

Sudden onset of muscle pain and stiffness

• Neck
• Shoulders
• Arms
• Pelvic girdle
• Thigh muscles

+/- muscle weakness (pain can contribute to weakness)

+/- fatigue, malaise, loss of appetite

Question 5

What is included in the DDX of Polymyalgia Rheumatica?

Answer 5

RA
Rotator cuff pathology
OA shoulders and hips
Fibromyalgia
Polymyositis/dermatomyositis
Spondyloarthrits
SLE
Vasculitides

Question 6

What are the labs in Polymyalgia Rheumatica?

Answer 6

ESR- > 40
CRP
CBC w/diff- look for anemia
Creatine phosphokinase (CPK)

Question 7

What is the criteria to diagnosis Polymyalgia Rheumatica?

Answer 7

Age of onset- >50

ESR >40

Pain > 1 month that involves 2

• Neck
• Shoulder
• Pelvic girdle

Absence of other disorders causing these symptoms

Morning stiffness > 1 hr

Rapid response to prednisone

Question 8

What is the treatment of Polymyalgia Rheumatica?

Answer 8

Prednisone 15-20 mg/day

• Long term add proton pump inhibitor to protect GI
• Calcium
• Vit D

Question 9

What is Giant Cell Arteritis in regards to Polymyalgia Rheumatica?

Answer 9

Targets medium to large extracranial blood vessels

Can affect ophthalmic artery leading to vision loss

More common in women

• Headache
• TTP over temporal artery
• Visual changes