Polymyalgia Rheumatica Flashcards by Luqman Tenang

Q

What is Polymyalgia Rheumatica (PMR)?

A

Inflammatory condition causing pain and stiffness in shoulder, pelvic gridle and neck

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Q

What disease is associated with PMR?

A

Giant Cell Arteritis

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Q

What is the demographic for PMR?

A

>50
Female
Caucasian

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Q

What are the core features of PMR?

A

Must present at least 2 weeks

Bilateral shoulder pain that may radiate to the elbow
Bilateral pelvic girdle pain
Worse with movement
Interferes with sleep
Stiffness for at least 45 minutes in the morning

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Q

What are the associated sx of PMR?

A

weight loss, fatigue, fever
depression
carpal tunnel syndrome
polyarthritis
tenosynovitis

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Q

What are the differentials for PMR?

A

RA
OA
Systemic lupus erythematosus
Polymyositis
Cervical spondylosis
Adhesive capsulitis
Hypothyroidism
Osteomalacia
Fibromyalgia

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Q

How would you diagnose PMR?

A

clinical presentation
response to steroids

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Q

What Ix would you order for PMR?

A

FBC
ESR and CRP high
Raised plasma viscosity
U&E
LFT
Calcium - raised in osteomalacia
Serum protein electrophoresis - myeloma
Thyroid function
CK - myositis
RhF - can be raised in PMR. RA
S-EMG (surface electromyography) - assess strength of muscles

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Q

What other Ix would you order for PMR?

A

ANA for SLE
Anti-CCP for RA
Urine Bence Jones protein for myeloma
CXR for lung and mediastinal abnormalities

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Q

How would you Mx PMR?

A

Prednisolone 15mg/d PO
Expect dramatic response in 1 week
If not - stop steroids, consider alternative diagnosis
If steroid response good, start reducing regime
- decrease dose 1mg/month
Biphosphonate, calcium and vit D supplements - bone protection
Methotrexate for pt at risk of relapse

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Q

What mnemonic can you use for PMR tx?

A

Dont STOP

after 3 weeks of tx, pt will become steroid dependant. Risk of adrenal crisis if abruptly stop
Sick day rules: increase dose if pt unwel
Treatment card for steroid
Osteoporosis prevention - biphosphonate and Ca
PPI

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