Polymyalgia Rheumatica

Question 1

What is polymyalgia rhematica?

Answer 1

inflammatory rheumatologic syndrome

Question 2

What is common epid of PMR?

Answer 2

• Women

- Older than 50

Question 3

What is PMR associated with?

Answer 3

15-20% patient with PMR have giant cell arteritis

Question 4

What are symptoms and signs of PMR?

Answer 4

1. Difficulty rising from seated or prone position
2. Shoulder and hip girdle stiffness
3. Muscle tenderness
4. Shoulder/hip bursitis
5. Oligoarthritis
6. Acute onset
7. Anorexia
8. Low grade fever

Question 5

What are possible DDx for PMR?

Answer 5

1. Giant cell arteritis
2. Early rheumatoid arthritis
3. Hypothyroidism
4. Fibromyalgia
5. Polymyositis

Question 6

What is the diagnosis of PMR based on?

Answer 6

history and elevated ESR and CRP

Question 7

What bloods are order and what is found in PMR?

Answer 7

1. ESR: elevated
2. CRP: elevated
3. FBC

Question 8

What is the management of PMR?

Answer 8

1. 1st line: corticosteroid e.g. prednisolone 12.5-25mg daily
   -calcium + vit D + bisphopsphonate
   -NSAID
2. 2nd line: methotrexate and folic acid
   3, 3rd line: tocilizumab

Question 9

How long does it take for PMR treatment to work?

Answer 9

Rapid improvement occurs within 24-72 hours with low dose prednisolone

Question 10

What are possible complications of PMR?

Answer 10

1. Chronic relapsing PMR
2. Increased risk of infection secondary toc orticosteroid
3. Osteoperosis secondary to corticosteroid
4. DMT2 to corticosteroid
5. Giant cell arteritis
6. Etc

Question 11

How long do patients need treatment for PMR?

Answer 11

2-3 years