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Polymyalgia Rheumatica symptoms , differential diagnosis and treatment

Definition
• It is a clinical syndrome characterized by muscle pain with stiffness in the neck, back, shoulders, upper arms , thighs and buttocks ,, Classically there is increased ESR
• Polyarthralgias or true synovitis can be present .
• It is not a true vasculitis but there is a association with giant cell arteritis.
normal-shoulder-joint-and-inflammation

How to diagnose Polymyalgia Rheumatica ?

C/P
Polymyalgia Rheumatica

 (It is a disease of elderly , the mean age of incidence is 70 years )
• The cardinal features are muscle stiffness and pain affecting mainly the proximal muscles of the upper arms and commonly the buttocks and thighs.
• Early morning stiffness with pain.
• Weight loss, depression, night sweats
• On examination there may be a painful restrictton of active shoulder  movement but passive movements are preserved.
- muscles may be tender.

Differential diagnosis of Polymyalgia Rheumatica 

Conditions that may mimic polymyalgia rheumatica
• Fibromyalgia.                    • Inflammatory myopathy.
• Cervical spondylosis.         • Rheumatoid arthritis.
• Malignancy.

Investigations 
High ESR, very occasionally the ESR is low (early).
CRP may be elevated prior to ESR.

How to manage Polymyalgia Rheumatica ?

Treatment
• Dramatic response within 72 hours to steroid 15 mg prednisolone /day and then tapering after 4-8 weeks, low dose maintenance may be
required for a time 5-10 mg/day.
Osteoporosis prophylaxis with bisphosphonates should be considered.
• Some patients require steroid sparing drugs e.g methotrexate or azathioprine.
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