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Polymyalgia Rheumatica

Reviewed 06/2019
 


BASICS

DESCRIPTION

  • A clinical syndrome characterized by pain and stiffness of the shoulder, hip girdles, and neck; primarily impacts the elderly, associated with morning stiffness and elevated markers ...

DIAGNOSIS

HISTORY

  • Suspect PMR in elderly patients with new onset of proximal limb pain and stiffness (neck, shoulder, hip). Patients may use the term stiffness and pain interchangeably (2).

  • Difficulty r...

TREATMENT

GENERAL MEASURES

  • Address risk of steroid-induced osteoporosis.

    • Obtain dual energy x-ray absorptiometry and check 25-OH vitamin D levels if necessary.

    • Consider antiresorptive therapies (bisphosp...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Monthly evaluations initially and during medication taper; every 3 months otherwise

  • Follow ESR as steroids are tapered; ESR and C-reactive protei...

REFERENCES

1
Muratore F, Pazzola G, Pipitone N, et al. Recent advances in the diagnosis and treatment of polymyalgia rheumatica. Expert Rev Clin Immunol.  2016;12(10):1037–1045. [View Abstract on ...

ADDITIONAL READING

  • Buttgereit F, Gibofsky A. Delayed-release prednisone—a new approach to an old therapy. Expert Opin Pharmacother.  2013;14(8):1097–1106. [View Abstract on OvidMedline]

  • Camellino ...

CODES

ICD10

  • M35.3 Polymyalgia rheumatica

  • M31.5 Giant cell arteritis with polymyalgia rheumatica

ICD9

  • 725 Polymyalgia rheumatica

  • 446.5 Giant cell arteritis

SNOMED

  • 65323003 Polymyalgia rheumatica (disorder)

  • 239...

CLINICAL PEARLS

  • Consider PMR in patients >50 years who present with hip, neck, and/or shoulder pain and stiffness.

  • A normal ESR does not exclude PMR.

  • Corticosteroids are the treatment of choice. If t...

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