Polymyalgia Rheumatica

Question 1

Define polymyalgia rheumatica

Answer 1

Inflammatory rheumatological syndrome -> pain and morning stiffness

Question 2

What are the causes/risk factors of polymyalgia rheumatica?

Answer 2

Unknown aetiology
• ?Viral trigger – adenovirus, parvovirus B19
• ?Genetic – HLA-DR4

Risk factors
• >50 years
• Female
• Giant cell arteritis (15-20% of patients with PMR have GCA)

Question 3

What are the symptoms of polymyalgia rheumatica?

Answer 3

Most commonly affects the neck, shoulder girdle and pelvic girdle
• Early morning stiffness >1 hour
• Morning pain >1 hour
• Low grade fever
• Anorexia
• Weight loss
• Malaise
• Depression

Question 4

What are the signs of polymyalgia rheumatica?

Answer 4

none

Question 5

What investigations are carried out for polymyalgia rheumatica?

Answer 5

• CRP/ ESR - elevated
• TSH - elevated if hypothyroidism is the cause of fatigue.
• USS - bursitis and joint effusion
• MRI - bursitis and joint effusion
• Serum Electrophoresis - normal; As some myeloproliferative diseases may also present similarly to PMR with symptoms of fatigue and bony pain and an elevated ESR, checking an FBC and serum protein electrophoresis is also recommended as part of PMR evaluation.

Question 6

What is the management for polymyalgia rheumatica?

Answer 6

• Corticosteroids: Prednisolone or methylprednisolone. Taper down dose, according to CRP/ESR and also symptoms.
• Osteoporosis Prophylaxis: Vitamin D, Calcium and Bisphosphonates. This is because corticosteroids can result in osteoporosis.
• Steroid-Sparring Agents e.g. Methotrexate. Adjuvant folic acid to prevent side effects due to methotrexate like bone marrow suppression.
• NSAIDs

Question 7

What are the complications of polymyalgia rheumatica?

Answer 7

• Relapsing PMR
• GCA
• Increased risk of infection secondary to corticosteroids
• Osteoporosis secondary to corticosteroids
• ILD due to methotrexate