Polymyalgia Rheumatica

Question 1

Define Polymyalgia Rheumatica

Answer 1

Inflammatory rheumatological syndrome that manifests as a pain and morning stiffness in individuals >50

Typically involves the neck, shoulder girdle and/or pelvic girdle

Question 2

Aetiology of Polymyalgia Rheumatica

Answer 2

Exact cause unknown

Suggested role of infectious agents e.g. adenovirus, RSV, parvovirus B18, chlamydia pneumoniae, Mycoplasma pneumoniae
Suggested role of genetic factors e.g. HLA-DRB1*04
Association with giant cell arteritis

Question 3

Risk factors for Polymyalgia Rheumatica

Answer 3

> 50
Giant cell arteritis
Female

Question 4

Symptoms of Polymyalgia Rheumatica

Answer 4

NO weakness

Shoulder/hip girdle stiffness (>1 hour | acute onset | bilateral)
Shoulder/hip girdle pain (>1 hour in the morning | acute onset | bilateral)
Low-grade fever
Anorexia or weight loss
Malaise
Depression
Asthenia (unaccustomed physical weakness of lack of energy)

Question 5

Signs of Polymyalgia Rheumatica on examination

Answer 5

Tenderness over the greater trochanteric and subacromial bursae
Restricted shoulder movements/hip movements

Question 6

Investigations for Polymyalgia Rheumatica

Answer 6

(rapid response to corticosteroids)

CRP/ESR: raised
FBC: variable, rule out myeloproliferative disease
TSH: ?hypothyroidism

USS: bursitis (trochanteric most common)| joint effusion
MRI: bursitis | joint effusion
Serum electrophoresis: normal (exclude myeloproliferative disease)

Question 7

Management for initial presentation of Polymyalgia Rheumatica

Answer 7

1. Corticosteroids e.g. prednisolone PO
2. Calcium + vit D + bisphosphonates e.g. alendronic acid + calcium carbonate + colecalciferol
3. NSAIDs e.g. naproxen

Second line: methotrexate + folic acid
Third: tocilizumab

Question 8

Management for ongoing Polymyalgia Rheumatica

Answer 8

1. Corticosteroids e.g. prednisolone PO
2. Calcium + vit D + bisphosphonates e.g. alendronic acid + calcium carbonate + colecalciferol
3. Methotrexate PO AND folic acid
4. Tocilizumab

Question 9

Complications of Polymyalgia Rheumatica

Answer 9

Chronic relapsing PMR
Giant cell arteritis
PMR-related vascular events

Corticosteroid use: risk of infection, T2DM, osteoporosis, HTN, muscle weakness, cataracts, glaucoma, skin changes

Methotrexate: methotrexate, oral ulcers, myelosuppression, hepatotoxicity, interstitial lung disease

Question 10

Prognosis of Polymyalgia Rheumatica

Answer 10

Overall is good
Response typically within 24-72 hours
Relapses or symptom exacerbations are common