Polymyalgia Rheumatica

Question 1

Who is affected by polymyalgia rheumatica. (2)

Answer 1

Older patients (>50). 
Women are more affected than men.

Question 2

What is the ratio of women:men affected by polymyalgia rheumatica.

Answer 2

2:1.

Question 3

What are the symptoms of polymyalgia rheumatica. (9)

Answer 3

Subacute onset of bilateral aching, tenderness, and morning stiffness in shoulders and proximal limb muscles.
Mild polyarthritis. 
Mild tenosynovitis.
Carpel tunnel syndrome (10%). 
Fatigue. 
Fever. 
Weight loss. 
Anorexia. 
Depression.

Question 4

What is the normal neurological finding in patients with polymyalgia rheumatica.

Answer 4

Normal muscle power.

Muscle weakness is not a features of this condition.

Question 5

What are the common blood findings in patients with polymyalgia rheumatica. (4)

Answer 5

Normocytic normochromic anaemia.
Raised ESR/CRP.
ALP is high in 30%.
Normal creatinine kinase levels (helps to distinguish from myositis/myopathies).

Question 6

What is polymyalgia rheumatica. (2)

Answer 6

It is not a true vasculitis.

Its pathogenesis is unknown.

Question 7

What type of onset is involved in polymyalgia rheumatica.

Answer 7

Subacute (

Question 8

What distinguishes polymyalgia rheumatica from myositis/myopathies.

Answer 8

Creatinine kinase is normal in polymyalgia rheumatica.

Question 9

What is the differential diagnosis for patients with polymyalgia rheumatica. (9)

Answer 9

Recent onset RA. 
Polymyositis. 
Hypothyroidism. 
Primary muscle disease. 
Occult malignancy or infection. 
Ostearthritis. 
Neck lesions. 
Bilateral subacrominal impingement. 
Spinal stenosis.