Polymyalgia Rheumatica

Definition

Symmetrical shoulder and thigh stiffness and pain of rapid onset (<2/12 to seek advice) and a clear response to prednisolone. ESR is usually raised.
Services: Rheumatology

When to refer

1. Unsure of diagnosis, seen soon.

2. Failure of response to 15 mg prednisolone.

3. If considering Giant Cell Arteritis commence 60 mg prednisolone daily and refer urgently to Ophthalmology (Mr Louis Clerkin). Rheumatology Referral

Investigations

• FBC
• ESR
• Biochemical Profile (P5)
• Protein electrophoresis
• Thyroid function
• Chest Xray

First Line Treatment

Trial of 15 mg Prednisolone od, initially for 2 weeks.
Then reduce to 5 mg daily over 3 months according to clinical response.
Keep at 5 mg to complete 2 years of therapy then tail off to nil or to minimal tolerated dose.

Schedule:

Start 15 mg for 1 month
Step reduce by 2.5 mg every month down to 5 mg daily (increase again to previous dose if symptoms return)
Maintain 5 mg for about 18 months
Tail reduce by 1 mg every month down to lowest tolerated dose
Slow tail very slow reduction occasionally have to accept long term therapy

Special Points

1. PMR often co-exists with OA/degenerative spinal disease and pain may reflect referred pain. Treat with simple analgesia.
2. Monitoring the ESR is mandatory but it is more important to act on the patient's symptoms.

Document Information
Expiry Date: 11/04/04
Author: Dr Tom Kennedy
Organisation: Arrowe Park Hospital