Polymyalgia Rheumatica

Background/Epidemiology

  • Inflammatory condition of unknown cause characterised by aching morning stiffness of the neck, shoulder and pelvic girdle
  • Fairly common (incidence ~85/100,000 / year); particularly in the elderly (average age of onset ~70 years and rarely diagnosed <50 years); more common in women (2-3:1)
  • Tends to be associated with Giant Cell Arteritis in between 20-40% (debate as to whether part of the same condition)
    • This can be an emergency as it can be sight limiting

Presentation

  • Suspect PMR in anybody >50, presenting with >2 weeks of
    • Bilateral shoulder, neck and/or pelvic girdle/hip pain; worse with movement; may trouble sleep; worse in the morning
      • May radiate to the elbows (75-90%); knees
    • Stiffness
      • should last at least 45 minutes after waking or periods of rest
      • may cause difficulty getting out of bed
  • Additional symptoms include
    • Low-grade fever, fatigue, anorexia, weight loss, depression
      • Occur in up to half
    • Arm tenderness (bilateral)
    • Carpal tunnel syndrome
    • Peripheral arthritis (predominantly knees and wrists)
    • Peripheral oedema
  • THERE IS NO WEAKNESS IN PMR (cf polymyositis)

Investigations

  • FBC- normochromic, normocytic anaemia
  • ESR/PV- raised
  • CRP- may be raised
  • It is prudent to check Renal function, LFTs, bone profile etc prior to starting steroids

Management

  • NB Prior to starting steroid, make sure that the patient does not have any features of GCA (as this may require higher doses and more urgent treatment)
  • Low dose steroids typically have a dramatic effect
    • 10-15mg daily initially will usually work overnight
      • Reduce the dose gradually
      • Patients may relapse but will again respond quickly to steroid treatment
      • Protect against bone loss as appropriate
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