Polymyalgia rheumatica

Question 1

describe the pain in PMR

Answer 1

severe bilateral pain and stiffness of shoulder and pelvic musculature. IF IT DOES NOT INCLUDE ONE OF THESE TWO THEN IT IS NOT PMR

Question 2

PMR often coexists with

Answer 2

GCA. always assess for it!!!!!!!!!!!!!!!

Question 3

additional symptoms to pain in PMR

Answer 3

morning stiffness >45 mins. may make it difficult to get out of bed/brush hair
flu like sx, generally shit

Question 4

what age PMR

Answer 4

NEVER UNDER AGE 50. usually 60-70. this goes for GCA too

Question 5

onset

Answer 5

acute or subacute

Question 6

investigations in PMR

Answer 6

ESR/CRP
FBC
LFT
CK

Question 7

which is better, ESR or CRP

Answer 7

CRP (only one case in the world ever where a patient has had low CRP and GCA. i think it’s similar for PMR

Question 8

what may be seen on the blood count in PMR

Answer 8

normocytic anaemia

thrombocytosis

Question 9

what LFT may be raised

Answer 9

alk phos. alk phos is generally a marker of infection anywhere in the body
(NB it also goes up for bone reasons)

Question 10

what might a patient say if they have scalp tenderness

Answer 10

can’t comb hair

can’t put head on pillow

Question 11

what exactly is jaw claudication

Answer 11

pain when chewing (NB it’s after a while, not on the 1st bite, more like the 10th

Question 12

if a patient is unwell wit ha raised ESR and CRP >100 what 3 things could it be

Answer 12

infection
malignancy
inflammatory condition

Question 13

how to differentiate between polymyositis and PMR (since they may present in a v similar way)

Answer 13

CK - raised in polymyositis

Question 14

rx PMR vs GCA

Answer 14

GCA 40mg pred (60mg eye sx)

PMR 15mg pred

Question 15

what is the name of the eye problem which causes blindness in GCA

Answer 15

ischaemic optic retinopathy

Question 16

what are the ACR classification criteria (5)

Answer 16

• age of onset >=50
• NEW onset headache
• temporal artery abnormality (pain on palpation, decreased pulsation)
• ESR >50 - NB CRP is actually a lot better to use
• abnormal temporal artery biospy

Question 17

do you treat straight away?

Answer 17

yes in GCA!!! or PMR with any head symptoms as this is likely GCA
don’t wait for biopsy (this can take days. you just need to treat straight away)
but if it is just PMR then you have a bit more time

Question 18

what other drug is given in PMR/GCA

Answer 18

aspirin (reduce thrombosis risk)

Question 19

difference between polymyositis and PMR

Answer 19

polymyostitis = weakness. NO PAIN
PMR = pain and stiffness, no weakness

Polymyositis = inflammatory, autoimmune. weakness. pain unusual BUT DOES HAPPEN 
PMR = always symmetriclaly painful muscles. not destructive to muscle