Polymyalgia rheumatica

Question 1

Define polymyalgia rheumatica

Answer 1

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

Question 2

Explain the aetiology/risk factors of polymyalgia rheumatica

Answer 2

UNKNOWN
Genetic and environmental factors

Associations
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

Question 3

Summarise the epidemiology of polymyalgia rheumatica

Answer 3

Relatively common

Occurs in people aged > 50 yrs

Peak age of onset: 73 yrs

3 x more common in FEMALES

Question 4

Recognise the presenting symptoms and signs of polymyalgia rheumatica

Answer 4

Tend to be relatively non-specific

Usual inclusion criteria for polymyalgia rheumatica:
Age > 50 yrs
Duration of symptoms > 2 weeks
Bilateral shoulder or pelvic girdle aching, or both
Morning stiffness lasting > 45 mins
High ESR/CRP

The characteristic clinical picture of polymyalgia rheumatica: bilateral shoulder pain and stiffness of acute or subacute onset with bilateral arm tenderness

NO WEAKNESS

Symptoms are worst when walking

Question 5

Identify appropriate investigations for polymyalgia rheumatica

Answer 5

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)

Question 6

Generate a management plan for polymyalgia rheumatica

Answer 6

CORTICOSTEROIDS (Miracle cure, quick onset)

Steroid-sparing agents (e.g. methotrexate) are sometimes used

Assistance from physiotherapy and occupational therapy

Monitor for adverse effects of steroids (e.g. osteoporosis

Question 7

Identify possible complications of polymyalgia rheumatica

Answer 7

Temporal arteritis

Relapse of disease

Complications of steroid use (e.g. fracture risk)

Question 8

Summarise the prognosis for patients with polymyalgia rheumatica

Answer 8

15% risk of getting temporal arteritis

Variable course and prognosis

Usually responds rapidly to steroid treatment

Relapse is common