Polymyalgia Rheumatica

Question 1

What is Polymyalgia Rheumatica?

Answer 1

A painful condition that causes stiffness and inflammation in the muscles around the shoulders, neck and hips. Not to be confused with polymyositis.

Question 2

What is the main difference between PMR and Polymyositis?

Answer 2

Polymyalgia rheumatica is not destructive to muscles. Polymyositis is.

Question 3

What demographics are more likely to have PMR? (2)

Answer 3

Female (x2 more likely).

Age over 70.

Question 4

What is the association of PMR and Giant Cell Arteritis (GCA)?

Answer 4

20% of PMR patients have GCA

50% of GCA patients have PMR

Question 5

How does PMR present? (3)

Answer 5

Sudden onset of bilateral:

• Aching
• Stiff shoulders (morning >45 mins)
• Tenderness

Occasional ones:
Synovitis, athralgia, carpal tunnel syndrome, depression, malaise,
weight loss & fever.

Question 6

Investigations and results for Polymyalgia Rheumatica. (4)

Answer 6

Raised CRP
Raised ESR
ALP (raised in 30% of cases)
Creatine Kinase (Normal)

Question 7

What is the diagnostic requirements for PMR? (4)

Answer 7

(technically there is no diagnostic criteria but…)

• Compatible History
• Age > 50
• ESR > 50
• Dramatic Steroid Response

Question 8

List some differential diagnoses for Polymyalgia Rheumatica? (6)

Answer 8

• MOI Joint Disease
• Underlying malignancy (lung cancer)
• Inflammatory muscle disease
• Hypo / Hyperthyroidism
• Bilater shoulder capsulitis (unlikely)
• Fibromyalgia (if FHx suggests)

Question 9

How do we treat polymyalgia rheumatica?

Answer 9

Prednisolone for 18-24 months.
Bone prophylaxis (whatever the fuck that means)