Polymyalgia Rheumatica

It is a systemic illness of the elderly.

Polymyalgia rheumatica causes sudden onset of severe pain and stiffness of the shoulder and neck, hips, lumbar spine (limb-girdle pattern).

The patient is always above 50 years.

CLINICAL FEATURES

The symptoms are worse in the morning and persist from 30 minutes to several hours. There is no muscle weakness as in polymyositis.

Because of stiffness and pain in the shoulders, hip, and lower back, patients have trouble combing their hair, putting on a coat, or getting up out of a chair.

• Systemic features such as fever, malaise, weight loss are common.

Differential diagnosis

• Polymyositis – proximal pain and weakness

• Polymyalgia rheumatica – proximal morning stiffness and pain.

. Myopathy – weakness, but no pain or stiffness.

Investigations

• ESR: markedly elevated and is the hallmark of polymyalgia rheumatica.

• Blood -FBE: anemia is almost always present.

• Temporal artery biopsy It shows giant cell arteritis in 10-30% of cases but is not usually performed.

Diagnosis is clinical.

Management

Prednisolone –  Dramatic response in 72 hours. The treatment duration is 6 months to 2 years.