Polymylagia Rheumatica Flashcards
What is PMR
Polymyalgia reumatica is an inflammatory condition associated with pain and stiffness in the shoulder, pelvic girdle and the neck
What is PMR related to
Temporal arteritis (GCA)
Who does PMR affect
Typically women over 50 - white
What is the path of PMR
Although linked to GCA - PMR is not a vasculitis process - it is associated with increase in interleukins and a fall in B cells
What is the onset of PMR
Rapid onset - symptoms need to be present for at least 2 weeks in order to make a diagnosis
What are the features of PMR
- Bilateral shoulder, pelvic girdle pain - pain is worse with movement and interferes with sleep
- Profound morning stiffness lasting longer than 45 min
What do we base our diagnosis on in PMR
Clinical features and investigations - remember that PMR is a diagnosis of exclusion
What investigations do we do in PMR
- Inflammatory markers (raised, and increase in plasma viscosity)
- Normal CK and EMG
How do we manage PMR
Steroids - give oral prednisolone daily
When do we consider alternate diagnosis in PMR
Trial steroids for a week - a feature of PMR is steroid responsiveness therefore if there is no response after a week, exclude PMR
When do we refer to rheumatology in PMR
Gradually titrate steroid therapy down until symptoms and inflammatory markers have resolved - this may take around a year however if taking longer than 2 years, refer to rheum
What is 2nd and 3rd line in PMR
2nd line = DMARDS
3rd line = tocilizumab
Don’t STOP for steroids
D - Dependent after 3 weeks therefore don’t stop to avoid addisonian crisis
S - Sick day rules.
T - treatment card to be carried by patient if steroid dependent
O - osteoporosis, consider adding bisphosphonates
P - PPI, steroids can increase acid secretion therefore consider giving omeprazole/lansoprazole
