polymyalgia rheumatica

Question 1

what is polymyalgia rheumatica?

Answer 1

A clinical syndrome characterized by pain and stiffness of the shoulder, hip girdles, and neck.

Patients may use the term stiffness and pain interchangeably.

Primarily impacts the elderly, associated with morning stiffness and elevated inflammatory markers.

Question 2

who is affected by polymyalgia rheumatica?

Answer 2

• Incidence increases with age.
• Average age of onset ~70 years
• Rare in people <50 years of age
• Peak incidence is between ages 70 and 80
• Is associated with GCA

Question 3

what is the classic history of a patient with polymyalgia rheumatica?

Answer 3

• suspect in elderly patients with new sudden onset of proximal limb pain and stiffness (neck, shoulders, hips)
• difficulty rising from chair or combing hair (proximal muscle involvement)
• night time pain
• systemic symptoms e.g fatigue, weight loss, low grade fever

Question 4

what will be observed in an examination of a patient with PMR?

Answer 4

• decreased ROM of shoulder, neck and hips
• muscle strength is usually normal, may be limited by pain/stiffness
• muscle tenderness

Question 5

how is a diagnosis of PMR made?

Answer 5

history + examination

raised inflammatory markers

check ESR or PV as well as CRP

consider temporal artery biopsy if symptoms of GCA

Creatinine kinase levels are normal helping to distinguish from myositis/myopathies

Question 6

how is PMR treated?

Answer 6

• dramatic (and diagnostic) response within 5 days of starting 15mg prednisolone daily
  (NB: if there is no dramatic and rapid response to steroids, reconsider diagnosis)
• taper slowly. Will usually need 18months of treatment.
• methotrexate can be steroid sparing in relapse patients

Question 7

what are some differentials for PMR?

Answer 7

• recent onset RA
• polymyositis
• hypothyroidism
• primary muscle disease
• occult malignancy/infection

Question 8

what is the difference between PMR and fibromyalgia?

Answer 8

Polymyalgia rheumatica is an inflammatory form of arthritis

Fibromyalgia does not show traditional signs of inflammation. Fibromyalgia pain is thought to be caused by overactive nerves that make the body perceive pain despite there being no physical injury.