Polymyalgia rheumatica Flashcards
description
inflammatory condition unknown cause severe bilateral pain morning stiffness of shoulder, neck, pelvic girdle ass. w/ GCA
epidemiology
84 per 100,000 almost exclusively >50yo peak age 73yo 2.4% lifetime risk women 1.7% men north european ancestry most commonly f:m 3:1
aetiology
cause unknown
both genetic and environmental
presentation
nonspecific
>50 subacute onset bilateral, severe persistent pain in neck, shoulders, pelvis
core inclusion criteria for PMR include:
age >50
bilateral shoulder and/or pelvic girdle aching
morning stiffness >45mins duration
evidence of acute phase response (ESR/CRP)
NB can be diagnosed with normal ESR/CRP if classical picture and response to steroids
may be flu-like Sx at onset
exclusion criteria:
current infection
cancer
GCA
DDx
inflammatory: RA late onset spondylarthropathy ank spond psoriatic arthritis SLE scleroderma Sjogren's vasculitis
non-inflammatory: OA spinal spondylosis rotator cuff disease frozen shoulder drug induced myalgia (statins) infections malignancy amyloidosis parkinsonism fibromyalgia depression endocrine metabolic
management
glucocorticoids only known effective treatment - prednisolone, 15mg/day for 3 weeks, then gradually reducing, usually for 2 years, maintenance dose 2.5-5mg/day
NSAIDs of little value
prevention and treatment of steroid induced osteoporosis
high fracture risk (eg >65):
bisphosphonate with calcium and vit D
DEXA not required
without high fracture risk:
calcium and vit D supplementation when starting steroids
DEXA recommended, and bisphosphonates may be recommended if T score is 1.5 or lower
requiring higher initial steroid dose:
bisp’s with calcium and vit D
relapse
the recurrence of PMR or development of GCA
initial treat clinical features of relapse
for further relapses, consider immunosuppression therapy eg methotrexate after two relapses
prognosis
GCA risk while PMR being treated is 15%
variable course and prognosis - depends on steroid response
relapse common
PMR not ass. w/ increased mortality
steroids side effects increase morbidity and mortality
