Polymyalgia
rheumatica Diagnosis
- Stiffness
- Often depressed - improves with steroids
- Polymyalgia rheumatica may be associated with giant cell arteritis, and it is important to ask about symptoms and signs of this condition
Investigation
- ESR normal in 30%
- C-reactive protein normal in 30%
- FBC for anaemia - AOCD
- Calcium, TFT, creatinine, alk phos, glucose, PSA
- CXR
- Electrophoresis
- Ultrasonography of the hip and shoulders, if available
Management
Trial of steroids: should be 80% better within 5 days
- 15mg/day for 4 weeks
- 12.5mg/day for 4 weeks
- 10mg/day for 4 weeks
- Then reduce by 1mg/month
50% can discontinue therapy within 2 years
Steroid treatment only deals with symptoms - symptoms last 2
years.
Azathioprine can be used for steroid-sparing effect (50-75mg/day).
NSAID useful for "aches and pains" while reducing steroids.
Don't treat raised ESR - wait for symptom recurrence.
BMJ clinical review 2008: Polymyalgia rheumatica
Additional educational resources
Resources for healthcare professionals
- American College of Rheumatology (www.rheumatology.org/educ/training/readinglist/index.asp)—Website containing information on rheumatological diseases, for physicians and patients
- Up to Date —Website designed to answer the clinical questions that arise in daily practice
- MD Consult (www.mdconsult.com/php/82911852-3/homepage)—Website that brings the leading medical resources together into one integrated online service to help doctors answer clinical questions and make better treatment decisions
Resources for patients
- American College of Rheumatology (www.rheumatology.org/public/factsheets/pmr_new2.asp)—Information for patients on polymyalgia rheumatica
- Arthritis Foundation (www.arthritis.org/disease-center.php?disease_id=20 )—Information and support for patients with arthritis and related conditions
- Patient UK (www.patient.co.uk/showdoc/500/)—Information leaflet on polymyalgia rheumatica
- Up to Date Patient Information (http://patients.uptodate.com/topic.asp?file=arth_rhe/5721)—Information on polymyalgia rheumatica and giant cell (temporal) arteritis
- Arthritis Research Campaign (www.arc.org.uk/arthinfo/patpubs/6032/6032.asp)—Information leaflet on polymyalgia rheumatica and support