Polymyalgia rheumatica Flashcards
what is polymyalgia rheumatica?
inflammatory condition
pain and stiffness in shoulders, pelvic girdle and neck
strong association with?
GCA
demographics
older adults >50
women
Caucasians
how long symptoms present for diagnosis?
more than 2 weeks
symptoms
bilateral shoulder pain radiate to elbow bilateral pelvic girdle pain worse with movement interfere with sleep stiff for atleast 45 mins in morning
other features
weight loss, fatigue, low grade fever
carpal tunnel
pitting oedema
differentials diagnosis
OA rheumatoid arthritis SLE myositis cervical spondylosis adhesive capsulitis thyroid fibromylagia
diagnosis
mainly on clinical presentation and response to steroids
ESR and CRP raised
Investigations prior to starting steroids
FBC, U+E, LFT calcium serum protein electrophoresis TSH creatine kinase RF urine dipstick
additional investigations to consider
ANA - SLE
anti-CCP = RA
urine bence jones protein
CXR
treatment
15mg prednisolone
1 week after - no response = stop
assess 3-4 weeks
reducing regimen - steroids
after 3-4 weeks reduce dose by 2.5mg then 1mg every 4-8weeks
how long to fully wean off steroids?
1-2 years
DON’T STOP mnemonic for long term steroids
DON’T = steroid dependent after 3 weeks and not stop taking due to risk of adrenal crisis
sick day rules - double dose
treatment card
osteoporosis = bisphosphonates and calcium/vitD
PPI
