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Polymyalgia rheumatica - Management
How do I know my patient has it?
- A diagnosis of polymyalgia rheumatica is mainly based on symptoms and signs, although there are some investigations that may help support the diagnosis.
- A common presentation is a person older than 50 years of age with [Dasgupta et al, 2007]:
- Bilateral shoulder and/or pelvic girdle aching lasting more than 2 weeks.
- Morning stiffness (for more than 45 minutes).
- Raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
- If symptoms or signs of giant cell arteritis are present (such as headache, scalp tenderness, visual symptoms), urgent management is needed (see the CKS topic on Giant cell arteritis).
- People with polymyalgia rheumatica usually respond rapidly to systemic corticosteroids, but this is not diagnostic as other conditions with similar presentation can also respond rapidly to steroids.
- Many features of polymyalgia rheumatica can lead to diagnostic error because the main symptoms occur in many other illnesses [Dasgupta et al, 2007]. For more information, see differential diagnosis.
- Several sets of criteria have been proposed to increase the uniformity and accuracy of diagnosis and are discussed in Diagnostic criteria.
- Consider referral to a rheumatologist to confirm the diagnosis.
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