Chapter: Medicine and surgery: Musculoskeletal system

Polymyalgia rheumatica - Vasculitis

A clinical syndrome characterised by pain and stiffness in the muscles of the pelvic and shoulder girdle associated with the development of giant cell (temporal) arteritis. - Definition, Incidence, Aetiology, Pathophysiology, Clinical features, Complications, Investigations, Management, Prognosis.

Polymyalgia rheumatica

 

Definition

 

A clinical syndrome characterised by pain and stiffness in the muscles of the pelvic and shoulder girdle associated with the development of giant cell (temporal) arteritis.

 

Prevalence

 

Common, affecting up to 1 in 150.

 

Age

 

Rare under 50 years.

 

Sex

 

2F : 1M

 

Aetiology

 

A history of polymyalgia rheumatica is present in 50% of patients with giant cell arteritis, 15% of patients with polymyalgia rheumatica will develop giant cell arteritis. The conditions may occur separately.

 

Clinical features

 

Gradual onset of pain, stiffness and perceived symmetrical weakness in shoulder neck and pelvic girdle. Systemic malaise, anorexia and weight loss may occur. Although fevers occur they are not as severe or swinging as seen in giant cell (temporal arteritis).


Investigations

 

The diagnosis is made clinically. There are very high inflammatory markers including ESR and CRP. There may be anaemia of chronic disease.

 

Management

 

Moderate dose prednisolone is used, and the therapy is monitored and tailored to the response of inflammatory markers. Generally treatment is required for 9‚Äď15 months, and prophylaxis against osteoporosis is essential.

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Medicine and surgery: Musculoskeletal system


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