Polymyalgia Rheumatica

Question 1

define Polymyalgia Rheumatica

Answer 1

An inflammatory condition that causes pain and stiffness in the shoulders, pelvic girdle, and neck.

Question 2

what disease is polymyalgia rheumatic associated with

Answer 2

There is a strong association to giant cell arteritis and the two conditions often occur together.
Both conditions respond well to treatment with steroids

Question 3

what causes polymyalgia rheumatica

Answer 3

The cause of Polymyalgia Rheumatica is not understood and there are no relevant antibodies.

Question 4

who does polymyalgia rheumatica affect

Answer 4

• older adults 50+
• white
• female

Question 5

differential diagnosis for polymyalgia rheumatica

Answer 5

• fibromyalgia
• myositis
• SLE
• hyper/hypo thyroidism
• rheumatoid arthritis
  -osteomalacia
• oesteorthritis

Question 6

when do symptoms of polymyalgia rheumatica start

Answer 6

Patients may have a relatively rapid onset of symptoms, from days to weeks, and the symptoms should be present for at least 2 weeks before a diagnosis of polymyalgia rheumatica is considered.

Question 7

features of polymyalgia rheumatica

Answer 7

• Systemic symptoms (weight loss, fatigue, fever)
• muscle tenderness
• Carpel tunnel syndrome
• Peripheral oedema
• bilateral Pain in the shoulders, pelvic girdle, and neck

Question 8

characteristics of the pain with polymyalgia rheumatica

Answer 8

• Worse in the morning
• Worse after rest or inactivity
• interferes with sleep
• Somewhat improves with activity
• takes at least 45 minutes to ease in the morning

Question 9

what is diagnosis for polymyalgia rheumatica based of

Answer 9

mainly based on:
- the clinical presentation
- response to steroids
- excluding differentials

Question 10

what do investigations for polymyalgia rheumatica find

Answer 10

• raised inflammatory markers
• normal creatinine

Question 11

how do polymyalgia rheumatica patients respond to steroids

Answer 11

Patients with PMR have a dramatic improvement after the initiation of steroids – if they don’t improve, consider another diagnosis.

Question 12

how to treat polymyalgia rheumatica

Answer 12

Corticosteroids
15mg prednisolone daily initially
Then begin reducing the dose by:
- 15mg until the symptoms are fully controlled
- 12.5mg for 3 weeks, then
- 10mg for 4-6 weeks, then
- Reducing by 1mg every 4-8 weeks

Question 13

why should steroids for polymyalgia rheumatica not be stopped suddenly

Answer 13

due to the risk of tertiary adrenal insufficiency.