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pmr

polymyalgia rheumatica

introduction

  • PMR is a clinical syndrome characterized by severe aching and stiffness in the neck, shoulder girdle, and pelvic girdle.
  • closely linked to temporal arteritis (giant cell arteritis)
    • 25% of patients with PMR experience temporal arteritis, and if this is present there is a risk of damage to the arteries of the eye which can rapidly lead to blindness.
    • 50% of patients with temporal arteritis will have PMR at the same time.
  • mainly a condition of those older than 50 years in whom it affects 1 in 200, but particularly females (M:F ratio 1:2), aged over 70 years.

clinical features

  • pain and aching of proximal muscle groups (hip/pelvis/shoulders/neck in particular), usually worse in the morning or after inactivity and of relatively abrupt onset
  • non-specific clinical findings
  • general constitutional symptoms of malaise, fatigue, low grade fevers, weight loss
  • muscle tenderness but no weakness or atrophy
  • rare complications include stroke (CVA) and abdominal aortic aneurysm (AAA)

differential diagnosis

confirmatory investigations

  • normochromic normocytic anaemia in 50% of cases
  • normal creatinine kinase level (thus excludes myositis)
  • negative finding for rheumatoid factor (thus makes rheumatoid arthritis less likely)
  • mild elevations in liver function test results
  • mild nonspecific synovitis
  • negative muscle biopsy findings

Mx

  • check for temporal arteritis
  • prednisolone 5-60mg/d in divided doses for 2 weeks, then taper, but may need Rx for 2-3 years
  • referral to rheumatologist
  • monitor erythrocyte sedimentation rate (ESR) to help guide prednisolone dosing
  • usually need monthly review then quarterly to watch for response to steroids and their complications.
  • exacerbations occur if steroid dose tapering is too rapid
pmr.txt · Last modified: 2009/09/09 12:47 (external edit)