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