Polymyalgia Rheumatica
NOT A TRUE VASCULITIS
pathogenesis unknown
frequently occurs alongside GCA
FEATURES
may be associated with
weakness IS NOT a feature
subacute onset (<2 weeks) of
Age >50yrs
tenderness
morning stiffness in
bilateral aching
hips
proximal limb muscles
shoulders
+/-
fatigue
fever
dec weight
anorexia
depression
mild polyarteritis
tenosynovitis
carpal tunnel syndrome
IX
NOTE: creatine kinase levels are normal = help distinguish myositis/myopathies
ALP inc 30%
ESR typically >40 (but may be normal)
inc CRP
DDX
hypothyroidism
primary muscle disease
polymyositis
occult malignancy or infection
recent onset RA
osteoarthritis [esp cervical spondylosis, shoulder OA)
neck lesions
bilateral subacromial impingement
spinal stenosis
MANAGEMENT
Prednisolone 15mg/d po
Expect a dramatic response within 1 week and consider an alternative diagnosis if not.
dec dose slowly, eg by 1mg/month (according to symptoms/esr)
Investigate apparent ‘flares’ during withdrawal—attributable to another condition?
Most need steroids for ≥2yrs, so give bone protection
Addition of methotrexate may be considered, for patients at risk of relapse/prolonged therapy
nsaids are NOT EFFECTIVE