polymyalgia rheumatica

Write about Polymyalgia Rheumatica here.


PMR causes a sudden onset of severe pain and stiffness of the shoulders and neck, and of the hips and lumbar spine - a limb girdle pattern.

• Symptoms are worse in the morning from 30 mins to several hours

• Clinical history is usually diagnostic

• Patient is ALWAYS over 50 years

• Patients develop systemic features of tiredness, fever, weight loss, depression and occasionally nocturnal sweats if it is not treated early.


Differentials:

Polymyositis - proximal pain and weakness

PMR - proximal morning stiffness and pain

• Myopathy - weakness, but no pain or stiffness


Investigations Of PMR:

• A raised ESR and/or CRP is a HALLMARK of the condition.  Rare to see PMR without an acute phase response.  If absent, Diagnosis should be questioned and the tests repeated a few weeks later before treatment is started

Serum alkaline phosphatase and gamma-glutamyltransferase may be raised

Anaemia (mild, normochromatic, normocytic) is often present

Temporal artery biopsy shows giant cell arteritis in 10-30% of cases, but is not usually performed

Treatment:

Corticosteroids produce a dramatic reduction of symptoms within 24-48 hours of starting treatment, provided dose is adequate

• Should reduce the risk of patients with PMR developing GCA

• NSAIDs are less effective and should not be used

• Disease settles after 12-36 months of treatment in about 75% of patients, but the remaining quarter continue to require low doses of corticosteroids for years

Starting dose for PMR: 10-15mg prednisolone as a single doss in the morning

• Dose reduction (and increases) are titrated against the response or recurrence of symptoms