Polymyalgia Rheumatica

 

• Definition

  • Idiopathic inflammation of shoulders, neck, and pelvic girdle.
  • 20% of patients also have giant cell arteritis, although there is no evidence of vasculitis causing PMR itself.

• Signs and symptoms

  • Acute/subacute onset of bilateral shoulder and pelvis muscle ache. However, no swelling or weakness.
  • Morning stiffness >45 minutes.
  • Other arthritic symptoms may be present: mild polyarthritis, tenosynovitis, carpal tunnel syndrome.
  • Systemic symptoms: weight loss, fever, fatigue, anorexia, and depression.

• Risk factors

  • Giant cell arteritis.
  • Female sex.
  • Age >60 years.

• Investigations

  • Inflammatory markers: ↑ESR, ↑CRP.
  • May have ↑alk phos.

• Management

  • Low dose prednisolone: start at 12.5-25.0 mg OD.
  • A rapid response to treatment (<7 days, usually 2 days) is required to confirm diagnosis. There is then usually a gradual further reduction in symptoms.
  • Taper dose down very gradually once symptoms resolve. Treatment usually continued for 1-3 years.
  • Monitor ESR/CRP until normalised, but no need to keep checking subsequently.
  • Consider adding methotrexate if there is inadequate treatment response, relapse, or severe side effects.