Polymyalgia Rheumatica Flashcards
1
Q
What is Polymyalgia Rheumatica (PMR)?
A
- Inflammatory condition causing pain and stiffness in shoulder, pelvic gridle and neck
2
Q
What disease is associated with PMR?
A
Giant Cell Arteritis
3
Q
What is the demographic for PMR?
A
- >50
- Female
- Caucasian
4
Q
What are the core features of PMR?
A
Must present at least 2 weeks
- Bilateral shoulder pain that may radiate to the elbow
- Bilateral pelvic girdle pain
- Worse with movement
- Interferes with sleep
- Stiffness for at least 45 minutes in the morning
5
Q
What are the associated sx of PMR?
A
- weight loss, fatigue, fever
- depression
- carpal tunnel syndrome
- polyarthritis
- tenosynovitis
6
Q
What are the differentials for PMR?
A
- RA
- OA
- Systemic lupus erythematosus
- Polymyositis
- Cervical spondylosis
- Adhesive capsulitis
- Hypothyroidism
- Osteomalacia
- Fibromyalgia
7
Q
How would you diagnose PMR?
A
- clinical presentation
- response to steroids
8
Q
What Ix would you order for PMR?
A
- FBC
- ESR and CRP high
- Raised plasma viscosity
- U&E
- LFT
- Calcium - raised in osteomalacia
- Serum protein electrophoresis - myeloma
- Thyroid function
- CK - myositis
- RhF - can be raised in PMR. RA
- S-EMG (surface electromyography) - assess strength of muscles
9
Q
What other Ix would you order for PMR?
A
- ANA for SLE
- Anti-CCP for RA
- Urine Bence Jones protein for myeloma
- CXR for lung and mediastinal abnormalities
10
Q
How would you Mx PMR?
A
- Prednisolone 15mg/d PO
- Expect dramatic response in 1 week
- If not - stop steroids, consider alternative diagnosis
- If steroid response good, start reducing regime
- decrease dose 1mg/month
- Biphosphonate, calcium and vit D supplements - bone protection
- Methotrexate for pt at risk of relapse
11
Q
What mnemonic can you use for PMR tx?
A
Dont STOP
- after 3 weeks of tx, pt will become steroid dependant. Risk of adrenal crisis if abruptly stop
- Sick day rules: increase dose if pt unwel
- Treatment card for steroid
- Osteoporosis prevention - biphosphonate and Ca
- PPI
