Polymyalgia rheumatica

Question 1

What is polymyalgia rheumatica?

Answer 1

Polymyalgia rheumatica (PMR) is an inflammatory rheumatological syndrome that manifests as pain and morning stiffness involving the neck, shoulder girdle, and/or pelvic girdle in individuals older than age 50 years.

Question 2

What are the risk factors for polymyalgia rheumatica?

Answer 2

> 50 years
giant cell arteritis (GCA)
female gender

Question 3

What are the signs and symptoms of polymyalgia rheumatica?

Answer 3

shoulder/hip girdle stiffness
shoulder/hip girdle pain
rapid response to corticosteroids
acute onset
low-grade fever
anorexia
weight loss

Question 4

What is the epidemiology of polymyalgia rheumatica?

Answer 4

For those 50 and older, the US prevalence has been estimated at 6/1,000, and the US average annual age- and sex-adjusted incidence estimated at 52.5/100,000. The incidence is higher in females at 61.7/100,000, compared with 39.9/100,000 in males.

Question 5

What are the investigations for polymyalgia rheumatica?

Answer 5

> ESR- elevated
CRP- elevated
FBC- variable
US- bursitis

Question 6

What is the management of polymyalgia rheumatica?

Answer 6

> Prednisolone
> Calc/ Vit D/ bisphosphonate
> NSAID (e.g. naproxen)
> Methotrexate/ folic acid (2nd line)
> Tocilizumab (3rd line)

Question 7

What are the complications of polymyalgia rheumatica?

Answer 7

> Chronic relapsing PMR
Steroids- T2DM, infections, osteoporosis etc.
PMR related vascular events
Methotrexate- ulcers, hepatotoxicity, ILD

Question 8

What is the prognosis of polymyalgia rheumatica?

Answer 8

The overall prognosis is good. Although response to treatment typically occurs within 24 to 72 hours, relapses or symptom exacerbations are common.