Arthritis - polymyalgia rheumatica
Description
- Inflammatory syndrome of bilateral shoulder and hip girdle pain and stiffness in people over 50
- Subacute onset over days-weeks; "I went to bed well and woke up 90 years old"
- Morning stiffness >45-60 min; cannot roll over in bed, lift arms to comb hair, or rise from a chair
- Pain is proximal and symmetrical; weakness is apparent, not real - power is normal when pain is overcome
- Systemic features in ~1/3: low-grade fever, weight loss, fatigue, malaise, depression
- Peripheral features in up to half - asymmetrical oligoarthritis (knee, wrist), carpal tunnel, distal extremity swelling with pitting oedema
- Bursitis and tenosynovitis, not myositis, is the pathology - CK is normal
The inseparable relationship with giant cell arteritis
- ~15-20% of PMR develops GCA; ~40-50% of GCA has PMR symptoms
- *Ask every PMR patient about GCA symptoms at every visit, and warn them to present immediately*
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