Relatively common chronic inflammatory condition of unknown aetiology that affects elderly individuals
Aetiology
Occurs almost exclusively in patients > 50 years
It is most common in patients with Northern European ancestry
Associated with giant cell arteritis
Approximately 15% of patients with PMR develop GCA, and 40-50% of patients with GCA have associated PMR
Clinical features
Symptoms
Proximal myalgia of the hip and shoulder girdles with accompanying morning stiffness that lasts for at least 45 mins
Usually symmetrical
Usually occurs relatively quickly - stiffness develops over a few weeks
Pain is worse with movement
Systemic symptoms such as fatigue, anorexia, weight loss and fever may occur
Signs
Reduced movement of shoulders, neck and hips
Muscle strength is normal
Upper arm tenderness
Carpel tunnel syndrome
Pitting oedema
Investigations
Mainly clinical diagnosis
The first-line investigations for polymyalgia rheumatica are indicative of the differentials, which include malignancy, endocrinopathy and metabolic bone disease
FBC, U+Es, LFTs, bone profile, protein electrophoresis, thyroid function tests, creatine kinase, rheumatoid factor, urinalysis
The most indicative investigations are inflammatory markers - can be markedly raised Bloods