Wednesday, 22 September 2010

MRCP revision battle 18.6: Polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is a slightly nebulous condition which the Oxford handbook defines as 'symmetrical aching, tenderness and morning stiffness in shoulders and proximal limb muscles, +/- systemic features'.  These systemic features can include anything from fatigue to anorexia...

It generally affects over 70s and is rare in under 60s.

Bloods tend to show a raised ESR

Treatment is with prednisolone (15mg PO OD) which tends to produce a dramatic improvement in days.  This should be decreased by 1mg per month, and of course anti-OP treatment should be given concurrently.

If symptoms recur on decreasing the dose and you have a lovely little old lady stuck on >10mg OD for over a year, it is worth considering methotrexate or azothioprine to try and allow you to decrease the steroid.

As a random aside, 10% of patients with PMR will suffer from carpal tunnel syndrome.

Now get ready to itch as we move on to the penultimate battle of the day, threadworm....