Polymyalgia Rheumatica Flashcards
1
Q
What is polymyalgia rheumatica?
A
an inflammatory condition
which causes pain and stiffness in the shoulders, pelvic girdle and neck
has a strong association with giant cell arteritis (often co-occur)
2
Q
Which demographic is commonly affected by polymyalgia rheumatica?
A
- It usually affects old adults (above 50 years)
- More common in women
- More common in caucasians
3
Q
How does polymyalgia rheumatica present?
A
- usually rapid onset (<1 month)
- bilateral aching and pain in shoulders, hips (pelvic girdle), stiffnes in proximal limb muscles (but NOT weakness)
- worse with movement
- stiffness for at least 45 mins in am
- interferes with sleep
- other symptoms: weight loss, fatigue, low grade fever, low mood, mild polyarthralgia, carpel tunnel
4
Q
What differentials should you consider in Polymyalgia Rheumatica?
A
- Osteoarthritis (esp cervical spondylosis, shoulder OA)
- Rheumatoid arthritis
- SLE
- Myositis/polymyositis
- Hypothyroidism
- Osteomalacia
- Fibromyalgia
- Malignancy (myeloma)
5
Q
What investigations would you do for Polymyalgia Rheumatica and how is it diagnosed?
A
Diagnosis mostly on clinical presentation and response to steroids
- Inflammatory markers - ESR (>40 tyoically but can be normal), CRP
- FBC, U+E’s, LFTs
- Calcium - raised in hyperthyroidism, cancer, low in osteomalacia
- Serum protein electrophoresis and Urine bence jones proteins* - Myeloma, other protein disorders
- TSH - thyroid function
- CREATININE KINASE, EMG - myositis
- Rheumatoid facotor, Anti-cyclic citrullinated peptide* for RA
- ANA - for SLE*
- Chest x-ray*
- urine dipstick
6
Q
How is polymyalgia Rheumatica managed?
A
start on 15mg prednisolone O/D
- patients typically respond dramatically within a week, within 2-3 weeks 70% symptom improvement
- if otherwise consider alternative diagnosis
