Polymyalgia Rheumatica:

Question 1

Polymyalgia Rheumatica:

How it presents?

Answer 1

Typical onset

• gradual or sudden
• involving neck, upper arms, lower back and thighs
• often associated with fatigue, depression, anorexia and weight loss

Question 2

Polymyalgia Rheumatica:

Diagnosis?

Answer 2

Diagnosis Pattern:
≥50yo
New bilateral shoulder or bilateral hip pain
Morning stiffness lasting ≥45min
Elevated ESR/CRP
Bilateral USS of impacted joint demonstrating inflammatory signs (effusion or ‘-itis’)
Negative RhF and anti-CCP AND peripheral synovitis

Importantly associated with Giant Cell Arteritis (15% of PMR patients)

Question 3

Polymyalgia Rheumatica:

Management?

Answer 3

Management:
Prednisolone
-15mg for 3 weeks, reducing 2.5mg every 3 weeks until
-10mg hold for 4 - 6weeks
-reduce by 1mg per month then cease
*if symptoms return then go up to next highest dose and hold for a while before trialing reduction

Specialist may use methotrexate to spare corticosteroid complications.

Always consider

• TB reactivation
• intercurrent illness
• exacerbating pre-existing weakness

Side effect considerations:

• if diabetic BGL monitoring BD and adjust management of diabetes accordingly
• BMD scan under medicare due to high dose and duration of steroid
• ideally prophylactic bisphosphonates (on PBS)
• BP monitoring
• GIT protection (gastritis, peptic ulcers)
• heart function (fluid retention and electrolyte changes)
• glaucoma and cataract formation monitoring
• mood/psychiatric side effects
• muscle weakness