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Polymyalgia Rheumatica

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Topic updated on 10/14/16 2:02pm

Snapshot
  • A 60-year-old woman presents Phototo her physician's office complaining of severe aching and stiffness in her neck, shoulders, and hips for last two months. She reports the pain to be much worse in the morning and shortly after awakening, and is often accompanied by fatigue and low-grade fevers. On exam, range-of-motion of the neck, shoulders, and hips is normal; however, the muscles are tender to palpation. Muscle strenth and sensation are normal. Serum creatinine kinase is 40 U/L, and ESR is 80.
Introduction
  • A rheumatologic disorder affecting the muscles of the cervical and pelvic girdles
  • Characterized by anatomically-specific, regional pain and stiffness
  • Most commonly seen in elderly females (>55 years of age)
  • Often associated with temporal arteritis
    • must rule-out in all diagnosed cases of polymyalgia rheumatica
Presentation
  • Symptoms
    • stiffness in shoulder and pelvic girdle
      • usually manifests as difficulty rising from sitting position
      • or challenging to lift arms above the head (deltoid weakness)
    • chronic, low-grade fever
    • fatigue or malaise
    • weight loss
  • Physical exam
    • muscle tender to palpation
    • reduced muscle strength and weakness may not be appreciated on physical exam
    • may identify signs of temporal arteritis
      • throbbing temporal pain
      • pain on palpation of temporal artery
Evaluation
  • Diagnosis is based primarily on patient history and clinical observations
  • Labs 
    • CBC may show anemia
    • markedly elevated ESR
    • Serum creatinine kinase (CK) is normal
Differential
  • Polymyositis; always rule out temporal arteritis in patients with PMR
  • Corticosteroid-induced myopathy - proximal muscle weakness; normal ESR & CK 
    • May present in a PMR patient being treated with chronic steroids; need to determine clinically whether the PMR is recurring and a greater steroid dose is needed or if this is a side-effect of the steroids and a reduction in dose is necessary 
Treatment
  • Medical management 
    • oral prednisone
      • first-line therapy
      • administered in low-dose (5-20 mg/day)
      • effective treatment in most cases
Prognosis, Prevention, and Complications
  • Prognosis
    • very good to excellent
    • most cases resolve with oral prednisone
  • Prevention
    • no preventive measures are available this time
  • Complications
    • may be accompanied by temporal arteritis which must be ruled-out
      • if undiagnosed, or untreated, can result in blindness


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