Polymyalgia Rheumatica

Question 1

Define

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.

NOTE: polymyalgia rheumatica does NOT cause weakness

Question 2

Causes

Answer 2

UNKNOWN

Genetic and environmental factors

Associations :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 3

Epidemiology

Answer 3

Relatively common

Occurs in people aged > 50 yrs

Peak age of onset: 73 yrs

3 x more common in FEMALES

Question 4

Symptoms

Answer 4

Presenting symptoms are nonspecific but PMR should be suspected in patients aged over 65 who have subacute to acute onset of bilateral, severe and persistent pain in the neck, shoulders and pelvic girdle

• Subacute onset of bilateral aching, tenderness and morning stiffness in shoulders and proximal limb muscles
• Pain on active and passive movements of these joints
• ±Systemic symptoms: fatigue, fever, ↓weight, anorexia,depression

NO WEAKNESS

Question 5

Signs

Answer 5

• 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

• ±Mild polyarthritis, tenosynovitis
• ±Carpal tunnel syndrome (in 10%)
• Oedema of hands/wrists/ankles feet
• Evidence of an acute phase response (↑ESR/CRP)

Question 6

Investigations

Answer 6

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 7

Management

Answer 7

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 8

Complications

Answer 8

Temporal arteritis

Relapse of disease

Complications of steroid use (e.g. fracture risk)

Question 9

Prognosis

Answer 9

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