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Polymyalgia Rheumatica

Juliana Chang, MD Reviewed 06/2022
 


BASICS

DESCRIPTION

  • A clinical syndrome characterized by pain and stiffness of the shoulder, hip girdles, and neck; primarily impacts patients over the age of 50. Associated with morning stiffness and e...

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). Shoulder p...

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
El Chami S, Springer JM. Update on the Treatment of Giant Cell Arteritis and Polymyalgia Rheumatica. Med Clin North Am. 2021 Mar;105(2):311-324. 
2
Lally L, Spiera R. Management of difficult...

ADDITIONAL READING

  • Figus FA, Skoczyńska M, McConnell R, Massazza G, Iagnocco A. Imaging in polymyalgia rheumatica: which technique to use? Clin Exp Rheumatol. 2021 Jul-Aug;39(4):8...

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

SNOMED

  • 65323003 Polymyalgia rheumatica (disorder)

  • 239938009 Giant cell arteritis with polymyalgia rheumatica ...

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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