Polymyalgia Rheumatica

Question 1

What is polymyalgia rheumatica?

Answer 1

Inflammatory condition causing pain and stiffness of the shoulders, neck and pelvic girdle

Question 2

What is polymyalgia rheumatica strongly linked to?

Answer 2

Giant cell arteritis

Question 3

What demographic does polymyalgia rheumatica commonly affect?

Answer 3

Caucasian women over 50

Question 4

How does PMR present?

Answer 4

FOR AT LEAST 2 WEEKS:

• Bilateral shoulder pain, radiates to elbow/Bilateral pelvic girdle pain
• Worse with movement
• Interferes with sleep
• Stiff for 45+ minutes in the morning

Question 5

What other features may suggest PMR?

Answer 5

• Systemic symptoms such as weight loss, low grade fever, and low mood
• Carpel tunnel
• Pitting oedema
• Upper arm tenderness

Question 6

What may your differentials be?

Answer 6

Shoulder: RA, OA, SLE, Adhesive capsulitis of the shoulders

Question 7

What is a PMR diagnosis largely based on?

Answer 7

• Clinical presentation

- Response to steroids

Question 8

What bloods are used in PMR?

Answer 8

• CRP
• Full profile to exclude others
• ANA (SLE)
• anti-CCP, RF (RA)

Question 9

What may be found in the urine with Myeloma?

Answer 9

Bence-Jones Protein

Question 10

How is PMR treated?

Answer 10

• 15mg prednisolone PO

Question 11

Describe the monitoring of PMR.

Answer 11

Assess 1 week after steroids initiated- if poor response, it’s probably not PMR and steroids should be stopped.

Assess 3-4 weeks after, the inflammatory markers should be normal now, and symptoms nearly resolved.

Question 12

If steroid response in PMR is good at 3-4 weeks, what should you do?

Answer 12

• 15mg until symptoms fully controlled
• Reduce to 12.5mg for 3 weeks
• Then 10mg for 4-6 weeks
• Then reduce by 1mg very 4-8 weeks

Increase if symptoms worsen, and advise Pt it could take 1-2 years to wean off

Question 13

What else should you prescribe with a long term steroid?

Answer 13

• Bisphosphonates
• Calcium and Vit D
• PPI

Question 14

What should a person with steroid treatment carry?

Answer 14

A steroid treatment card

Question 15

How does giant cell arteritis present?

Answer 15

• Severe, unilateral headache around the temple/forehead

Question 16

What other features should you ask for with giant cell arteritis?

Answer 16

• Jaw claudication
• Scalp tenderness
• Blurred/double vision
• Systemic symptoms (weight loss, lost app., fever and muscle aches)

Question 17

What can occur rapidly in giant cell arteritis?

Answer 17

Irreversible, painless, complete sight loss

Question 18

How is giant cell arteritis diagnosed?

Answer 18

• Temporal artery biopsy
• Raised CRP
• Clinical diagnosis

Question 19

What is found on temporal artery biopsy with giant cell arteritis?

Answer 19

Multinucleated giant cells

Question 20

How is giant cell arteritis treated?

Answer 20

Prednisolone 40-60mg

higher dose if jaw claudication or visual symptoms

Question 21

What again is prescribed along with prednisolone?

Answer 21

• Bisphosphonates
• Calcium and Vit D
• PPI

Question 22

What is prescribed to reduce vision loss in giant cell arteritis?

Answer 22

Aspirin 75mg

Question 23

What are the complications of giant cell arteritis?

Answer 23

• Vision loss
• CVA
• Aortitis and aortic dissection
• Relapses