Polymyalgia Rhuematica

Question 1

What is polymyalgia rheumatica?

Answer 1

An inflammatory condition that causes pain + stiffness in shoulders, pelvic girdle + neck

Question 2

Common demographic of polymyalgia rheumatica

Answer 2

People with giant cell arteritis
Older white patients
Average age of onset ~ 70

Question 3

Presentation of polymyalgia rheumatica

Answer 3

• pain + stiffness in shoudlers, pelvic girdle + neck
• worse in morning + after rest
• takes >45 mins to ease in morning
• difficult rising from chair or combing hair
• somewhat improves with activity
• night time pain > interferes with sleep > fatigue
• reduced ROM
• reduced muscle strength
• muscle tenderness

Question 4

Diagnosis of polymyalgia rheumatica

Answer 4

• Diagnosis made based on clinical presentation + supported by raised inflammatory markers (ESR, PV + CRP)
• consider temporal artery biopsy or USS if symptoms of GCA

Question 5

Investigations of polymyalgia rheumatica

Answer 5

Done to exclude differentials
- FBC
- U&E + urine dipstick
- LFT
- calcium
- rheumatoid factor + anti CCP
- anti-nuclear antibodies
- chest X ray

Question 6

Management of polymyalgia rheumatica

Answer 6

15mg prednisolone OD
- If there is not a dramatic + rapid response to steroids, re consider diagnosis
- steroids tapered away slowly after 12 years

Question 7

What additional management should be put in place for people on long term steroids?

Answer 7

• bisphophonates, calcium + vit D for osteoporosis prevention
• PPIs for gastro protection
• patient should carry a steroid treatment card to alerts others that they are steroid dependent