Polymyalgia rheumatica is an inflammatory condition of adults over 50 that causes pain and morning stiffness in the shoulders, neck and hips. It responds quickly to low-dose steroids, and some patients also have giant cell arteritis, which can cause blindness.
Key symptoms
- Aching and stiffness in both shoulders, the neck and hips
- Morning stiffness lasting over 45 minutes
- Trouble getting out of bed, rising from a chair or lifting the arms
- Fatigue, low fever, poor appetite or weight loss
What you find on exam
- Painful, limited shoulder and hip motion
- No true muscle weakness, which separates it from myositis
- Temporal artery tenderness and a vision check for giant cell arteritis
- Joints for synovitis that might suggest rheumatoid arthritis
Tests
- ESR and CRP raised
- Normal creatine kinase
- Blood count, kidney, liver and thyroid tests, rheumatoid factor and anti-CCP to rule out mimics
- Shoulder ultrasound may show bursitis
Treatment basics
- Low-dose prednisone, usually 12.5 to 25 mg daily, with a fast response
- Slow taper over a year or more, guided by symptoms and markers
- Bone protection: calcium, vitamin D and often a bisphosphonate
- Methotrexate as a steroid-sparing drug for relapses
Red flags
- New headache, jaw pain with chewing or scalp tenderness
- Sudden vision loss or double vision
- No improvement on low-dose steroids, which points to another diagnosis
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.