Polymyalgia rheumatica

Polymyalgia rheumatica - Acute

 

Definition  

Inflammatory condition characterized by pain and morning stiffness in the neck, shoulder, and pelvic girdles

 

 

Monitoring Disease Activity  

 

Suspected and known polymyalgia rheumatica  

* Serum C reactive protein level: C-reactive protein (CRP) is a sensitive indicator of disease activity at both diagnosis and during recurrence of polymyalgia rheumatica .

 

Diabetes Mellitus Monitoring  

 

Suspected diabetes mellitus  

* Plasma fasting glucose measurement: Fasting plasma glucose levels of 126 mg/dL (7 mmol/L) or greater are diagnostic of diabetes mellitus. In the absence of unequivocal hyperglycemia, results must be confirmed with repeat testing on another day .

 

Osteoporosis Monitoring  

 

Osteoporosis  

* Dual energy X-ray photon absorptiometry

 

Hypercholesterolemia Monitoring  

 

Suspected and known hypercholesterolemia  

* Serum cholesterol measurement: The incidence of coronary heart disease is proportional to serum total cholesterol. Total cholesterol of less than 200 mg/dL is optimal; 200 to 239 mg/dL is borderline high; 240 mg/dL or greater is high .

 

Medical History  

* Temporal arteritis

 

Findings  

* Pain

* Stiffness

* Limitation of joint movement

* Skeletal muscle tender

* Joint swelling

* Muscle atrophy

* Fatigue

* Loss of appetite

* Fever

* Night sweats

* Weight loss

* Carpal tunnel syndrome

* Depression

 

Tests  

 

Suspected and known polymyalgia rheumatica  

* Erythrocyte sedimentation rate measurement: An erythrocyte sedimentation rate of at least 40 mm/hour is one of the diagnostic criteria for diagnosing polymyalgia rheumatica .

 

Suspected and known polymyalgia rheumatica  

* Serum C reactive protein level: C-reactive protein (CRP) is a sensitive indicator of disease activity at both diagnosis and during recurrence of polymyalgia rheumatica .

 

Suspected polymyalgia rheumatica  

* Magnetic resonance imaging: Tenosynovitis, bursitis, or a joint effusion seen on MRI can aid in the diagnosis of polymyalgia rheumatica .

 

Suspected polymyalgia rheumatica  

* Ultrasonography: Tenosynovitis, bursitis, or a joint effusion seen on ultrasound can aid in the diagnosis of polymyalgia rheumatica .

 

Suspected anemia  

* Complete blood count

 

Differential Diagnosis  

* Temporal arteritis - Chronic

* Rheumatoid arthritis - Chronic

* Remitting seronegative symmetrical synovitis with pitting edema

* Ankylosing spondylitis - Chronic

* Systemic lupus erythematosus - Chronic

* Polymyositis - Acute

* Fibromyalgia - Chronic

* Hypothyroidism - Chronic

* Infective endocarditis

* Amyloidosis - Chronic

* Multiple myeloma - Chronic

* Malignant lymphoma

* Leukemia

* Cancer

* AIDS

* Calcium pyrophosphate deposition disease

* Systemic vasculitis

* Subdeltoid bursitis

* Shoulder tendinitis

* Polyarteritis nodosa

* Thyrotoxicosis

* Parkinson's disease - Chronic

* Hepatitis

 

Treatment  

 

Drug Therapy  

 

Polymyalgia rheumatica  

 

PREDNISONE  

Adults: 10 to 20 mg/day orally for up to one month, then reduce the daily dosage by 2.5 to 5 mg every month as tolerated until 10 mg/day, then reduce by 1 to 2.5 mg/day every month until therapy is discontinued

 

 

Patients taking long-term corticosteroids who are at risk for developing osteoporosis  

 

CALCIUM  

Adults: 1200 mg/day orally

 

Vitamin D  

Adults: 800 international units/day

 

Non-Procedural Therapy  

 

Polymyalgia rheumatica  

* Physical Activity