Write about Polymyalgia Rheumatica here.
• PMR causes a sudden onset of severe pain and stiffness of the shoulders and neck, and of the hips and lumbar spine - a limb girdle pattern.
• Symptoms are worse in the morning from 30 mins to several hours
• Clinical history is usually diagnostic
• Patient is ALWAYS over 50 years
• Patients develop systemic features of tiredness, fever, weight loss, depression and occasionally nocturnal sweats if it is not treated early.
• Polymyositis - proximal pain and weakness
• PMR - proximal morning stiffness and pain
• Myopathy - weakness, but no pain or stiffness
Investigations Of PMR:
• A raised ESR and/or CRP is a HALLMARK of the condition. Rare to see PMR without an acute phase response. If absent, Diagnosis should be questioned and the tests repeated a few weeks later before treatment is started
• Serum alkaline phosphatase and gamma-glutamyltransferase may be raised
• Anaemia (mild, normochromatic, normocytic) is often present
• Temporal artery biopsy shows giant cell arteritis in 10-30% of cases, but is not usually performed
• Corticosteroids produce a dramatic reduction of symptoms within 24-48 hours of starting treatment, provided dose is adequate
• Should reduce the risk of patients with PMR developing GCA
• NSAIDs are less effective and should not be used
• Disease settles after 12-36 months of treatment in about 75% of patients, but the remaining quarter continue to require low doses of corticosteroids for years
• Starting dose for PMR: 10-15mg prednisolone as a single doss in the morning
• Dose reduction (and increases) are titrated against the response or recurrence of symptoms