Polymyalgia rheumatica Flashcards
1
Q
What is polymyalgia rheumatica?
A
A clinical syndrome characterized by pain and stiffness of the shoulder, hip and neck.
2
Q
Is the pathogenesis of PMR known?
A
No
3
Q
Who is the typical patient for PMR?
A
- Over 50
4
Q
What are the clinical features of PMR in the history?
A
- New sudden onset (<2wks) of proximal limb pain and stiffness
- Difficulty with proximal limb movement (combing hair, rising from chair)
- Night time pain
- Systemic symptoms - fatigue, weight loss, low grade fever
5
Q
What are the clinical features of PMR upon examination?
A
- Decreased ROM of shoulders, neck and hips
- Muscle strength is usually normal
- Muscle tenderness
6
Q
What condition is PMR associated with?
A
Giant cell arteritis
7
Q
What investigations would you undertake?
What would be the results?
A
- Raised ESR>40/Raised CRP
- Alkaline phosphatase raised in 30%
- Creatine kinase is normal (so it is not a myositis/myopathy)
8
Q
What is the treatment for for PMR?
A
- 15mg of prednisolone daily
- Titrate dose down by 1mg/month according to symptoms and ESR
- Most need steroids for over 2 years so give bone protection
9
Q
How quick will the response to PMR be?
A
- Expect a dramatic response within 1 week and if not consider an alternative diagnosis
