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.
(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.
• Cervical spondylosis. • Rheumatoid arthritis.
• Malignancy.
Investigations
High ESR, very occasionally the ESR is low (early).
CRP may be elevated prior to ESR.
• 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.
• 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.
How to diagnose Polymyalgia Rheumatica ?
C/P
(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.