Table of Contents
- 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.
- 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
- occult infection
- erythrocyte sedimentation rate (ESR) > 50 mm/h
- 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
- 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 by 127.0.0.1