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Polymyalgia Rheumatica

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This condition occurs in the female: male ratio 2:1; in England up to 400 per 100,000 patients over 65 years age have this illness.

Age of onset tends to be over 50 years of age, average being 70 years.

General features: Abrupt onset of Fever; Malaise; Fatigue; Night sweats; Pain.

Pain is:

  • Symmetrical (although it may be unilateral(one side) at onset
  • Involves shoulder, neck, and hip girdle and is greatest after inactivity & sleeping

There may be an associated arteritis which can cause visual disturbance and cerebral (brain) ischaemia (impaired blood supply).

There may also be depression and weight loss

Laboratory tests:

  • ESR: > 40
  • Anaemia of chronic disease
  • Negative: ANA & Rheumatoid factor
  • Muscle biopsy may reveal abnormalities
  • In the acute phase: high serum C-reactive protein and cytokine levels (inflammatory mediators)

Associated disorders: Giant cell (Temporal) arteritis occurs in 20- 50%.

Treatment: Prednisone (steroid)  gives a rapid response in 75%, response being best with  those who have short disease course, relatively lower inflammatory markers.

Course: Often self-limited: 18 to 24 months