Polymyalgia Rheumatica is an inflammatory condition characterised by pain and stiffness of the shoulder, neck, and pelvic girdle. It frequently occurs with Giant Cell Arteritis (GCA). The symptoms respond quickly to treatment with oral corticosteroids.
It rarely occurs in those < 50 years of age and affects women more than men.
- Risk factors
- Infectious trigger, e.g. adenovirus and respiratory syncytial virus
- HLA-DRB1
- Pathophysiology
- Cytokine and immune-cell-mediated inflammation of periarticular structures
- Signs and symptoms
- Bilateral aching, tenderness and stiffness
- Affects the shoulders, hips, and proximal limb muscles
- Lasts at least 45 minutes
- Subacute onset (< 2 weeks)
- Fatigue
- Fever
- Weight loss
- Anorexia
- Depression
- Polyarthritis
- Tenosynovitis
- Carpal tunnel syndrome (105)
- No weakness
- Bilateral aching, tenderness and stiffness
- Differentials
- Recent-onset rheumatoid arthritis
- Polymyositis
- Fibromyalgia
- Hypothyroidism
- Hyperparathyroidism
- Primary muscle disease
- Occult malignancy or infection: multiple myeloma, acute leukaemia, lymphoma, or lung cancer (pancoast tumour)
- Osteoarthritis (cervical spondylosis and shoulder osteoarthritis)
- Neck lesions
- Overuse bursitis or tendonitis
- Bilateral subacromial impingement
- Bilateral adhesive capsulitis
- Spinal stenosis
- Viral illness
- Statin-induced myopathy
- Investigations
- Elevated CRP and ESR
- Treatment
- Oral steroids
- The condition improves within 1 week of starting
- If it does not improve, consider an alternative diagnosis.
- Treatment may be protracted
- Methotrexate for patients at risk of relapse or prolonged therapy
- NSAIDs are ineffective
- Oral steroids
- Complications
- Complications of corticosteroids
- Osteoporosis
- Increased risk of infection
- Type 2 diabetes
- Hypertension
- Cataract
- Glaucoma
- Skin thinning and bruising
- Giant cell arteritis
- Complications of corticosteroids
