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Clinical Medicine > Polymyalgia Rheymatica > Flashcards

Polymyalgia Rheymatica Flashcards

1
Q

What is polymyalgia Rheymatica?

A

idiopathic inflammatory condition causing synovitis, bursitis, and tenosynovitis leading to pain/stiffness of the proximal joints (shoulder, hips, neck) in patients >50 years old

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2
Q

Is polymyalgia Rheumatica common in younger patients?

A

No

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3
Q

What demographic does PMR mainly affect?

A

Middle aged and elderly

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4
Q

What is the prevalence of PMR inpatients older than 65 years?

A

3300 per 100,000 patients

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5
Q

What causes PMR?

A
  1. Polygenetic (with an environmental trigger)
  2. Viral cause is suspected
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6
Q

Which demographic is PMR most common in?

A
  1. Elderly increase prevalence in those of European background (F:M 2:1)
  2. PMR associated with HLA class II genes
  3. relapsing PMR more common in patients with HLA-DRB1*04 allele
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7
Q

What are some of the clinical features of PMR?

A
  1. Onset
    *dramatic or insidious
    *related to recent bereavement (stage of grief)
  2. Constitutional symptoms
    *fever
    *fatigue
    *anorexia
    *depression
  3. Pyrexia of unknown origin
    *Fever of unknown origin
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8
Q

How is the musculoskeletal system affected with PMR? (Pt1)

A
  1. Pain and stiffness (S: worse after rest, predominant feature)
    *Shoulder and neck (MC, proximal joints)
    *Distal involvement unusual
    *Bilateral and symmetric
  2. Muscle pain
    *often diffuse (not a particular muscle group)
    *pain at night is common
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9
Q

How is musculoskeletal system affected by PMR?(pt2)

A
  1. Muscle strength
    *usually unimapaired
  2. Muscle atrophy
    *may occur in late stages
    *restriction of joint movement (improves with steroids)
  3. Tenderness of involved structures including periarticular structures
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10
Q

What are the features of synovitis in patients with PMR?

A
  1. Asymmetric peripheral arthritis
    *knees, wrists, sternoclavicular joints
    *transient
  2. Carpal tunnel syndrome
  3. Abnormal technetium pertechnetate scintigrams (bone scans)
    *in shoulders, knees, wrists, and hands
  4. Improve with steroids
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11
Q

What is the diagnostic criteria for PMR?

A
  1. Age >65
  2. ESR >40mm/hr
  3. Bilateral upper arm tenderness
  4. Morning stiffness> 1 hour
  5. Onset of illness within 2 weeks
  6. Depression or weight loss or both
    *Dx requires 3 of 7 listed features
    *presence of 4 confirms a sensitivity of 92% and specificity of 80%
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12
Q

What are the normal ESR values?

A

0-19mm/hr

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13
Q

What is the difference between PMR and GCA?

A

PMR
*Does not cause blindness
*Responds to low-dose prednisone (10-20mg)
GCA
*can cause blindness and large artery complications
*requires high-dose prednisone (60mg)

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14
Q

What are the lab findings associated with PMR?

A
  1. ESR
    *usually greatly increased >50mm/hr
  2. CRP
    *indicator of disease activity (higher levels mean the worse the patient is doing)
  3. Anemia (CBC w/ diff)
  4. Protein electrophoresis
  5. Abnormalities in LFT may be present
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15
Q

What is the treatment for PMR?

A

Prednisone 10-20*mg po QD (low-dose)
*will be a rapid response
*is there is a lack of response (re-think diagnosis)

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16
Q

How should you taper a patient off of prednisone?

A
  1. Start tapering after approx 2-4 weeks after tx has begun
  2. Tapering increments should not be more than >5mg
  3. Once 10mg QD is reached then taper 1g every 2-4 weeks
    *warn patients of expected relapse for at least 2 years
    *treatment should last for at least a year
17
Q

What is the tapering schedule for the initial dose of prednisone?

A
  1. 10-20*mg initially for 1 month
  2. Reduced by 2.5 mg for every 2-4 weeks to 10mg daily
18
Q

What is the tapering schedule for the maintenance dose?

A
  1. 5-7mg daily for 6-12 months
  2. Final reduction 1mg every 6-8 weeks
  3. Treatment needs to happen for at least a year
19
Q

If a patient has a recurrence of symptoms what should happen to the prednisone tx?

A

Increase the prednisone dose

20
Q

What should be used if a patient cannot reduce the prednisone dosage or develops seriousn steroid s/e?

A

Use methotrexate

21
Q

What are the complications of continuous prednisone use?

A
  1. Increase the risk of osteoporosis
    *asses the risk of osteoporosis before starting Rx
    *Calcium and vitamin D supplements

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