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Polymyalgia rheumatica: clinical update
1FRACP, Senior Advanced Trainee Registrar, Thoracic Medicine, Royal Adelaide Hospital, and Clinical Associate Lecturer, Discipline of Medicine, University of Adelaide, SA.
Background:
Polymyalgia rheumatica is a relatively common inflammatory rheumatic disease. There are no validated international guidelines available for the diagnosis and treatment of PMR; however, diagnostic and classification criteria are currently being developed.
Objective:
The aim of this article is to summarise the main management options suggested by American College of Rheumatology and discusses the role of the general practitioner in the diagnosis and early management of PMR.
Discussion:
Diagnosis is made on the basis of a combination of clinical and laboratory findings. Patients typically present with shoulder and hip girdle pain with pronounced stiffness. Inflammatory markers are usually elevated and an ultrasound and MRI of the shoulder and hip can be done to localise inflamed tissues. Response to steroids should not be used as a defining feature of PMR but treatment with low dose prednisone should be considered. PMR has an excellent prognosis if diagnosis is prompt and therapy adequate.
Insights
Polymyalgia rheumatica (PMR) is an inflammatory condition causing pain and stiffness, especially in the shoulders and hips. Early diagnosis and treatment, guided by clinical findings and inflammatory markers, lead to an excellent prognosis.
Area of Science:
- Rheumatology
- Internal Medicine
Background:
- Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease.
- Current international guidelines for PMR diagnosis and treatment are lacking, though criteria are under development.
Purpose of the Study:
- To summarize American College of Rheumatology management recommendations for PMR.
- To discuss the general practitioner's role in diagnosing and managing PMR.
Main Methods:
- Review of American College of Rheumatology management options for PMR.
- Discussion of diagnostic indicators and imaging techniques.
Main Results:
- PMR diagnosis relies on clinical presentation (shoulder/hip girdle pain, stiffness) and elevated inflammatory markers.
- Ultrasound and MRI can identify inflamed tissues in affected joints.
Conclusions:
- Prompt diagnosis and adequate therapy, potentially including low-dose prednisone, are crucial for PMR.
- PMR generally has an excellent prognosis with timely intervention.
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