Polymyalgia rheumatica

Polymyalgia rheumatica is an inflammatory rheumatic disease characterized by: 

• Bilateral shoulder and/or pelvic girdle aching 
• Morning stiffness >45 minutes duration 
• Raised ESR
• Systemic symptoms
• Low grade fever 
• Weight loss 

Average age of onset is >70. It is very rare in those <50.

Females > males (3:1) 

People of north European ancestery more likely to be affected.

There is evidence of a link to HLA DR4 

Treatment 

• Oral prednisolone – 15mg OD – tends to improve condition dramatically within days. Taper dose to lowest level that works. 
• Limit risks of adverse effects of steroid treatment, e.g. with osteoporosis prophylaxis. 
• IM methylprednisolone may be used in milder cases and may reduce the risk of steroid-related complications. 

Complications associated with PMR:

• Carpel tunnel syndrome
• Giant cell arteritis (30%)

References

Dasgupta, B. et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology (Oxford). 2010; 49(1): 186-190. 

Michet, C. and Matteson, E. Polymyalgia rheumatic. BMJ. 2008; 336(7647): 765-769. 

Van Hecke, O. Polymyalgia rheumatica – diagnosis and management. Aus Fam Physician. 2011; 40(5): 303-306.