Polymyalgia Rheumatica (PRM)

Question 1

What is PMR?

Answer 1

Pain + stiffness of muscles in proximal extermities w. no associated muscle weakness (closely related to giant cell arteritis)

Question 2

1. What disease is PMR closely related to?
2. What % of pts w. PMR have this disease?
3. what % of pts w. this disease have PMR?

Answer 2

1. Giant cell arteritis
2. 15%
3. 30%

Question 3

What are some symptoms that indicate a pt may be developing this condition associated w. PMR?
Does developing these symptoms require urgent assessment (and why?)?

Answer 3

New headache, 
Scalp tenderness, 
Sudden painless loss of vision/diplopia, 
Jaw/tongue claudication,
temporal tenderness/reduced pulsations  

Yes - medical emergency b/c untreated GCA –> blindness in 20-25%

Question 4

Key PMR Hx/Ex findings

Answer 4

Subacute onset (

Question 5

Key PMR Hx/Ex findings

Answer 5

Subacute onset (

Question 6

Key Ix to order

+ expected findings

Answer 6

ESR > 40, 
CRP elevated, 
CK normal, 
ALP elevated (30%),
FBE (sometimes anemia + high platelets)

Question 7

Do normal inflammatory markers rule out Dx

Answer 7

No (-ve in 5%), but less likely

Question 8

Which tests help distinguish PMR from myopathies/myosis

Answer 8

CK (normal - c.f. elevated)

Creatinine kinase released from damaged muscles

Question 9

What is the Rx? How long do most pts required Rx?

Answer 9

Prednisolone - most required for 2y

Question 10

What is the Rx? How long do most pts required Rx?

Answer 10

Prednisolone - most required for 2y

Question 11

What measures are taken re: side effects of Rx?

Answer 11

Bone protection = bisphosphonates, vit D, calcium

Gastric protection = PPI

Question 12

How is Rx discontinued?

Answer 12

Slow tapering of dose (~1mg/month) guided by symptoms + ESR

Question 13

Alternate Rx (if original Rx not tolerated)

Answer 13

Methotrexate

Question 14

How common is relapse? How are they Rx?

Answer 14

50% 
aggressive Rx (high-dose steroids)

Question 15

The common cx are associated w. Rx - what are some SEs to look out for w. each RX?

Answer 15

STEROIDS

• low bone density
• gastric ulcers
• T2DM
• immunosuppression

METHOTREXATE

• interstitial lung disease
• oral ulcers (stomatitis)
• hepatotixicity (monitor LFTS)
• myelosuppression