Polymyalgia Rheumatica

Question 1

What is PMR? What is it characterised by?

Answer 1

inflammatory condition causing proximal myalgia of neck, hip + shoulder girdles with morning stiffness that lasts > 1 hour

Question 2

What is the relationship between PMR and giant cell arteritis?

Answer 2

15% of patients with PMR develop GCA

40-50% of patients with GCA have associated PMR

Question 3

Describe the aetiology of PMR

Answer 3

Unknown

Question 4

Describe the epidemiology of PMR

Answer 4

Relatively common
Occurs in people aged > 50 yrs
F > M 3:1

Question 5

List 5 core inclusion criteria for a diagnosis of PMR

Answer 5

Age > 50 yrs  
Duration of symptoms > 2 weeks  
Bilateral shoulder/ pelvic girdle aching, or both  
Morning stiffness lasting > 45 mins  
High ESR/CRP

Question 6

Describe the classic clinical presentation of a patient with PMR

Answer 6

bilateral shoulder pain + stiffness of acute/ subacute onset with bilateral arm tenderness

Question 7

List 4 features of symptoms caused by PMR

Answer 7

NO WEAKNESS
Symptoms are worst when walking
Morning stiffness may be so bad that they find it difficult to get up, or raise their arms enough to brush their hair
May be flu-like symptoms at onset

Question 8

List 9 investigations used in suspected PMR

Answer 8

ESR/CRP (raised)
FBC 
U+Es 
LFTs 
Rheumatoid factor
Bone profile  
Protein electrophoresis  
TFTs 
Creatine kinase  
Autoantibodies e.g. anti-CCP antibodies

Question 9

Describe the management plan for PMR

Answer 9

Glucocorticoids e.g. prednisolone
Steroid-sparing agents (e.g. methotrexate) sometimes used
Physiotherapy + OT
Monitor for adverse effects of steroids (e.g. osteoporosis)

Question 10

List 3 complications of PMR

Answer 10

Giant cell arteritis
Relapse of disease
Complications of steroid use (e.g. fracture risk)

Question 11

Describe the prognosis of PMR

Answer 11

15% risk of GCA while being treated
Variable course + prognosis
Usually responds rapidly to steroid tx
Relapse is common