Polymyalgia rheumatica: Difference between revisions
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==Management== | ==Management== | ||
*Low-dose [[Corticosteroids]] typically produce rapid response<ref>https://emedicine.medscape.com/article/330815-overview</ref> | *Low-dose [[Corticosteroids]] typically produce rapid response<ref>https://emedicine.medscape.com/article/330815-overview</ref> | ||
**Example regimen: | |||
***[[Prednisone]] 15 mg PO QD for 2-4 weeks | |||
***Needs to start a year-long taper after the first month, so write enough for them to get in with PCP. | |||
*Avoid [[NSAIDs]] if history of or concern for [[GCA]] due to risk of renal injury | *Avoid [[NSAIDs]] if history of or concern for [[GCA]] due to risk of renal injury | ||
Latest revision as of 20:35, 13 September 2023
Background
- Chronic inflammatory condition
- Primarily affects elderly
- Almost exclusively in those over the age of 50, peak incidence occurs between ages 70-80[1]
Clinical Features
- Onset abrupt or subacute (weeks-months)
- Proximal myalgia primarily involving hips, shoulders, and neck
- Morning stiffness
- Giant cell arteritis develops in approximately 15% of patients with PMR[2]
- +/- constitutional symptoms (fatigue/malaise, low-grade fever, anorexia)
- +/- anemia
- Rheumatoid arthritis-like symptoms (joint pain/swelling, degenerative changes) in 30% of patients[3]
Differential Diagnosis
Myalgia
- Infection:
- Viral infection (e.g. Influenza)
- Bacterial infection
- Spirochete infection (E.g. Dengue fever; Trichinella)
- Drugs:
- Statins
- Bisphosphonates
- Corticosteroids
- Ciprofloxacin
- Clofibrate
- Colchicine
- Chloroquine
- Emetine
- Aminocaproic acid
- Zidovudine
- Bretylium
- Penicillamine
- Drugs causing hypokalemia
- Metabolic disorders:
- Vitamin D deficiency
- Mitochondrial myopathy
- Scurvy
- Osteomalacia
- Fibromyalgia
- Endocrine:
- Polymyalgia rheumatica
- Rhabdomyolysis
- Myositis
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Inclusion body myositis
- Sarcoidosis
- Scleroderma
- Sjögren’s syndrome
- Psychiatric (e.g. somatic manifestations of depression)
- Domestic abuse
- Crush injury
- Lyme disease
- Ehlers-Danlos syndrome(hypermobility syndrome)
- HIV myopathy
- Hypophosphatemia
- Hypokalemia
- Hypothermia
- Prolonged immobility
- Strenuous exercise (overuse) or heat stroke
- Seizure
- Severe volume contraction
- Alcoholism
- Muscular dystrophy
- Duchenne
- Becker
- Limb-girdle
- Facioscapulohumeral
- Myotonic dystrophy
- Myotonia congenita
- Compartment syndrome; Muscle infarction
- Neuropathic
- Chronic fatigue syndrome
- Vasculitis
- Sarcocystosis
- Spinal stenosis
- Diabetic lumbosacral plexopathy
Evaluation
- Clinical diagnosis
- Evaluate for alternate diagnoses
Management
- Low-dose Corticosteroids typically produce rapid response[4]
- Example regimen:
- Prednisone 15 mg PO QD for 2-4 weeks
- Needs to start a year-long taper after the first month, so write enough for them to get in with PCP.
- Example regimen:
- Avoid NSAIDs if history of or concern for GCA due to risk of renal injury
Disposition
- Discharge
See Also
External Links
References
- ↑ Salvarani C, Gabriel SE, O'Fallon WM, Hunder GG. Epidemiology of polymyalgia rheumatica in Olmsted County, Minnesota, 1970-1991. Arthritis Rheum. 1995 Mar;38(3):369-73. doi: 10.1002/art.1780380311. PMID: 7880191.
- ↑ Dejaco C, Duftner C, Buttgereit F, Matteson EL, Dasgupta B. The spectrum of giant cell arteritis and polymyalgia rheumatica: revisiting the concept of the disease. Rheumatology (Oxford). 2017 Apr 1. 56 (4):506-515
- ↑ https://rarediseases.org/rare-diseases/polymyalgia-rheumatica/
- ↑ https://emedicine.medscape.com/article/330815-overview