Polymyalgia Rheumatica Flashcards
Define Polymyalgia Rheumatica?
An inflammatory condition of unknown cause, which is characterised by severe bilateral pain and morning stiffness of the shoulder, neck and pelvic girdle
What is the important thing about Polymyalgia Rheumatica?
Doesn’t cause weakness
What is the aetiology of Polymyalgia Rheumatica?
Genetic and environmental factors
What are the associations of Polymyalgia Rheumatica?
Temporal Arteritis
How is Temporal Arteritis linked with Polymyalgia Rheumatica?
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
What is the epidemiology of Polymyalgia Rheumatica?
Relatively common
Occurs in people aged > 50 yrs
Peak age of onset: 73 yrs
3 x more common in FEMALES
What are the nature of the symptoms and signs of Polymyalgia Rheumatica?
Tend to be relatively non-specific
What is the usual inclusion criteria for Polymyalgia Rheumatica?
Age > 50 yrs Duration of symptoms > 2 weeks Bilateral shoulder or pelvic girdle aching or both Mornign stiffness lasting > 45 mins High ESR/CRP
What is the characteristic clinical picture of Polymyalgia Rheumatica?
Bilateral shoulder pain and stiffness of acute or subacute onset with bilateral arm tenderness
(IMPORTANT) NO WEAKNESS
Symptoms 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
What are the main investigations for Polymyalgia Rheumatica?
ESR/CRP - raised in Polymyalgia Rheumatica FBC U&Es LFTs Bone profile Protein electrophoresis TFTs Creatine Kinase
What are the other investigations for Polymyalgia Rheumatica?
Urinary Bence Jones proteins
Autoantibodies (e.g. anti-CCP antibodies)
What is the management plan for Polymyalgia Rheumatica?
CORTICOSTEROIDS
Steroid-sparing agents (e.g. methotrexate) are sometimes used
Assistane from physiotherapy and occupational therapy
Monitor for adverse effects of steroids (e.g. osteoporosis)
What are the possible complications of Polymyalgia Rheumatica?
Temporal arteritis
Relapse of disease
Complications of steroid use (e.g. fracture risk)
What is the prognosis for patients with Polymyalgia Rheumatica?
15% risk of getting temporal arteritis
Variable course and prognosis
Usually responds rapidly to steroid treatment
Relapse is common
