Polymyalgia rheumatica (PMR)
Giant Cell (temporal) Arteritis (GCA)
- Develops in 15% of PMR
- NB jaw claudication, scalp tenderness
- Beware ischaemic idiopathic retinopathy (25% of GCA) causing blindness
- Amaurosis fugax (10% of GCA)
- Early treatment with 60mg - 80mg Prednisolone / day
- GCA Dx by biopsy
- Abrupt onset proximal (shoulder / hip girdle) myopathy (difficulty rising from chair)
- Morning stiffness > 1 hour
- Unknown aetiology
- Self limiting condition, usually resolves in 3 yrs
- During flare patients feel unwell, poor quality of life
- Systemic upset: low grade fever, wt loss, malaise, depression
Labs
- ESR usually >40mm/h (occasionally normal ESR but Dx on rapid response to steroids)
- CRP often reflects ESR
- Normocytic, normochromic anaemia ("chronic disease")
- Thrombocytosis
- ALT and Alk Phos may be raised, albumin decreases
- CK in normal
- ANA and rheumatoid factor negative
Management PMR
- Beware GCA (temporal arteritis)
- PO steroids (improve myalgia, constitutional symptoms and lab findings)
- ± NSAIDs initially for myalgia
- Admit for Bx if any suspicion GCA
- PO steroids and GP if well
- May require immunosuppression later if poor response to steroids
Content by Dr Íomhar O' Sullivan 06/01/2011. Last review Dr ÍOS 18/06/21.