Polymyalgia Rheumatica

Question 1

Definition

Answer 1

An inflammatory condition of unknown cause, which is characterised by severe
bilateral pain and morning stiffness of the shoulder, neck and pelvic girdle.

o NOTE: polymyalgia rheumatica does NOT cause weakness

Question 2

Aetiology

Answer 2

• UNKNOWN

* Genetic and environmental factors

Question 3

Associated condition

Answer 3

o Temporal Arteritis

• 40-50% of people with temporal arteritis have polymyalgia rheumatica
• 15% of people with polymyalgia rheumatica will go on to develop temporal
arteritis
• Both conditions respond to corticosteroids

Question 4

Epidemiology

Answer 4

• Relatively common
• Occurs in people aged > 50 yrs
• Peak age of onset: 73 yrs
• 3 x more common in FEMALES

Question 5

Presenting symptoms and signs on physical examination

Answer 5

• Tend to be relatively non-specific
• The characteristic clinical picture of polymyalgia rheumatica: bilateral shoulder pain and stiffness of acute or subacute onset with bilateral arm tenderness
• NO WEAKNESS
• Symptoms are worst when walking
• Morning stiffness may be so bad that they find it difficult to get out of bed, or raise their arms enough to brush their hair
• May be flu-like symptoms at onset

Question 6

Inclusion criteria

Answer 6

Usual inclusion criteria for polymyalgia rheumatica:

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

Question 7

Investigations

Answer 7

• ESR/CRP - raised in polymyalgia rheumatica
• FBC
• U&Es
• LFTs
• Bone profile
• Protein electrophoresis
• TFTs
• Creatine kinase
• Others: urinary Bence Jones proteins, autoantibodies (e.g. anti-CCP antibodies)

Question 8

Management plan

Answer 8

• CORTICOSTEROIDS
• Steroid-sparing agents (e.g. methotrexate) are sometimes used
• Assistance from physiotherapy and occupational therapy
• Monitor for adverse effects of steroids (e.g. osteoporosis)

Question 9

Possible complications

Answer 9

• Temporal arteritis
• Relapse of disease
• Complications of steroid use (e.g. fracture risk)

Question 10

Prognosis

Answer 10

• 15% risk of getting temporal arteritis
• Variable course and prognosis
• Usually responds rapidly to steroid treatment
• Relapse is common