Polymyalgia Rheumatica - finished Flashcards
Define polymyalgia rheumatica
A common, chronic inflammatory rheumatic clinical syndrome of unknown cause in which severe pain and stiffness of the muscles of the shoulder and pelvic girdles are accompanied by a variety of systemic ssx.
There is no associated permanent weakness or atrophy
Epidemiology of PMR
F:M = 2:1
>50yoa
Increased in caucasians
What are the key features of PMR
Proximal muscle group:
- pain (severe)
- stiffness (morning >1 hr)
Pathology of PMR
No evidence of specific histological changes or inflammatory infiltrates in the muscles (rules out PMDM)
Periarticular findings found in PMR:
Pathological: synovitis, bursitis and tenosynovitis
Main areas affected are: shoulder girdles, hip girdles and neck
Proposed pathological mechanism:
- genetically predisposed individual is exposed to a trigger and monocytes are activated. These monocytes produce cytokines (specifically IL2 and IL6). These cause the ssx of PMR and giant cell arteritis
Increase IL2 is seen in most cases of PMR
Increased IL6 correlates with increased disease activity
Signs of PMR
Shoulder girdle is usually first to become symptomatic Have few physical findings: - slow and difficult movements - absence of muscle weakness - +/- small synovial effusions - transient synovitis and bursitis - Tenderness on palpation of muscles in girdle - distal peripheral joint swelling
Symptoms of PMR
Muscle aching/pain (persistent)
- Areas most affected = neck, pelvic girdle, pectoral girdle, upper back
Morning stiffness and gelling post inactivity
- occurs in the same muscles as the pain but worse in:
- shoulder and hip girdles
- morning stiffness lasts longer than 60minutes
Swelling and stiffness in proximal joints (25% pts)
Carpal tunnel syndrome (15% pts)
Systemic complaints of PMR
May precede appearance of arthralgia and myalgia by 6 months
Malaise Fever (low grade) Depression/apathy Weight loss/ anorexia Lethargy Fatigue
