Polymyalgia Rheumatica

Question 1

Typical age group affected by polymyalgia rheumatica

Answer 1

> 50yrs

Question 2

Characteristic feature of polymyalgia rheumatica

Answer 2

proximal myalgia of the hip and shoulder girdles with accompanying morning stiffness for > 1 hour

Question 3

What disease is polymyalgia rheumatica associated with?

Answer 3

giant cell arteritis - approx 15% develop GCA; 40-50% of GCA patients have PMR

Question 4

Presenting features of polymyaglia rheumatica

Answer 4

Sore/stiff but no weakness, reduced movement due to pain, normal strength (no inflammation), fatigue, anorexia, weight loss and maybe fever, rapid onset (weeks)

Question 5

Diagnosis of Polymyalgia Rheumatica

Answer 5

exclude other diagnosis - there are no autoantibodies for PMR. Blood tests - raised CRP, ESR and PV

Question 6

Treatment of Polymyalgia Rheumatica

Answer 6

rapid and dramatic response to 15mg of prednisolone. This is reduced over an 18month period

Question 7

Histological findings in giant cell arteritis

Answer 7

transmural inflammation across the intima, media and adventitia of the artery. There may be infiltration by lymphocytes, macrophages and multi-nucleated giant cells

Question 8

Pathophysiology of giant cell arteritis

Answer 8

Vessel wall thickening leads to distal ischaemia

Question 9

Signs and Symptoms of giant cell arteritis (4)

Answer 9

headache - temporal area; jaw claudication - tiredness/aching on chewing; visual loss - black curtain over one eye; tender, enlarged but non-pulsatile artery

Question 10

Diagnosis of giant cell arteritis

Answer 10

temporal artery biopsy (which may be negative), raised inflammatory markers

Question 11

Treatment of giant cell arteritis

Answer 11

no visual loss - 40mg prednisolone; with visual loss - 60mg of prednisolone –> taper dose over 18 months