Polymyalgia Rheumatica

Question 1

What are the features of polymyalgia rheumatica?

Answer 1

• Shoulder/hip/girdle stiffness. Usually early morning stiffness which lasts for over 1 hour. Associated inflammatory pain. Symptoms usually resolve within 72 hours of steroids.
• Systemic symptoms include low grade fever, reduced appetite, weight loss and malaise.

Question 2

How can you distinguish polymyalgia rheumatica from myositis?

Answer 2

Myositis can cause bilateral proximal muscle weakness but pain is absent. Whereas in polymyalgia rheumatica there shouldn’t be any weakness on examination, they will be very stiff and painful.
Summary - Myositis no pain, PR painful

Question 3

What are the investigations for polymyalgia rheumatica?

Answer 3

Investigations: most indicative are ESR and CRP. However essential investigations are;
- FBC
- Urea and electrolytes
- LFTs
- Bone profile
- Protein electrophoresis
- TFT
- Creatinine kinase (normal)
- Rheumatoid factor
- Urinalysis

Question 4

What is the treatment for polymyalgia rheumatica?

Answer 4

Steroids. Failure to respond should cause prompt consideration of alternative diagnosis.