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Polymyalgia Rheumatica

Reviewed 06/2018
 


BASICS

DESCRIPTION

  • A clinical syndrome characterized by pain and stiffness of the shoulder, hip girdles, and neck. Patients may use the term stiffness and pain interchangeably (1).

  • Primarily impacts the...

DIAGNOSIS

HISTORY

  • Suspect PMR in elderly patients with new onset of proximal limb pain and stiffness (neck, shoulder, hip).

  • Difficulty rising from chair or combing hair (proximal muscle involvement)

  • Nigh...

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 (bispho...

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 CRP should declin...

REFERENCES

1
Mackie SL, Hughes R, Walsh M, et al. “An impediment to living life”: why and how should we measure stiffness in polymyalgia rheumatica? PLoS One.  2015;10(5):e0126758. [View Abstract...

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...

SEE ALSO

Arteritis, Temporal; Arthritis, Rheumatoid (RA); Depression; Fibromyalgia; Osteoarthritis; Polymyositis/Dermatomyositis 

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.

  • If there is not a dramatic and rapid response to ...

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