Polymyalgia Rheumatica Flashcards
Define polymyalgia rheumatica
DEFINITION: an inflammatory condition of unknown cause, which is characterised by severe bilateral pain and morning stiffness of the shoulder, neck and pelvic girdle.
NOTE: polymyalgia rheumatica does NOT cause weakness
Explain the aetiology/risk factors of polymyalgia rheumatica
- UNKNOWN
- Genetic and environmental factors
- Associations;
A. Temporal Arteritis
- 40-50% of people with temporal arteritis have polymyalgia rheumatica
- 15% of people with polymyalgia rheumatica will go on to develop temporal arteritis
- Both conditions respond to corticosteroids
Summarise the epidemiology of polymyalgia rheumatica
Relatively common
Occurs in people aged > 50 yrs
Peak age of onset: 73 yrs
3 x more common in FEMALES
Recognise the presenting symptoms and signs of polymyalgia rheumatica
Tend to be relatively non-specific
Usual inclusion criteria for polymyalgia rheumatica:
- Age > 50 yrs
- Duration of symptoms > 2 weeks
- Bilateral shoulder neck, &/or pelvic girdle aching, - - Morning stiffness lasting > 45 mins
- High ESR/CRP
acute or subacute onset with bilateral arm tenderness
NO WEAKNESS
Symptoms are worst when walking
Morning stiffness may be so bad that they find it difficult to get out of bed, or raise their arms enough to brush their hair
May be flu-like symptoms at onset
Identify appropriate investigations for polymyalgia rheumatica
ESR/CRP - raised in polymyalgia rheumatica FBC U&Es LFTs Bone profile Protein electrophoresis TFTs Creatine kinase Others: urinary Bence Jones proteins, autoantibodies (e.g. anti-CCP antibodies)
What is the utility of ESR in diagnoses of conditions?
ESR is raised in inflammatory states;
The RBCs form roleuax/clump together faster than normal = raised ESR
Generate a management plan for polymyalgia rheumatica
CORTICOSTEROIDS
Steroid-sparing agents (e.g. methotrexate) are sometimes used
Assistance from physiotherapy and occupational therapy
Monitor for adverse effects of steroids (e.g. osteoporosis)
Identify possible complications of polymyalgia rheumatica
Temporal arteritis
Relapse of disease
Complications of steroid use (e.g. fracture risk)
What is the CRP test?
C-reactive protein is found in blood plasma and its levels rise in response to inflammation.
Why would you order a Creatine Kinase check for this condition?
You want to exclude other causes of the muscle pain other than polymyalgia. I.E.;
High CK in the blood may be an indication of damage to CK-rich tissue, such as in rhabdomyolysis, myocardial infarction, myositis and myocarditis.
Why would you order a Creatine Kinase check for this condition?
You want to exclude other causes of the muscle pain other than polymyalgia. I.E.;
High CK in the blood may be an indication of damage to CK-rich tissue, such as in rhabdomyolysis, myocardial infarction, myositis and myocarditis.
What is a steroid sparing agent
Sometimes immunosuppressive medications are given in addition to or instead of steroid therapy to lower the dose of steroids needed and thus spare some of the undesirable side effects of steroid therapy. For this reason, these drugs are sometimes called “steroid-sparing”
Summarise the prognosis for patients with polymyalgia rheumatica
15% risk of getting temporal arteritis
Variable course and prognosis
Usually responds rapidly to steroid treatment
Relapse is common
What is temporal arteritis? Aetiology?
Temporal arteritis is a chronic vascular disease of unknown origin occurring in the elderly, characterized by granulomatous inflammation in the wall of medium-size and large arteries .
Although any large artery may be affected, it is the branches of the carotid artery that result in the majority of the symptoms and signs. The condition primarily affects the aorta and its extracranial branches.
A new onset localized headache that is usually unilateral, in the temporal area,
There is a significant clinical overlap with polymyalgia rheumatica.
