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Polymyalgia rheumatica - Management
What investigations should I do?
- There are no diagnostic tests that can be routinely carried out in primary care to diagnose polymyalgia rheumatica. However, the following may help to support a diagnosis:
- Erythrocyte sedimentation rate (ESR).
- The ESR is typically higher than 40 mm per hour.
- However, the ESR may be normal at presentation and even during a flare of disease activity (relapse). At presentation, 7–20% of people with polymyalgia rheumatica have an ESR less than 40 mm per hour.
- C-reactive protein (CRP) is typically elevated.
- Full blood count.
- Normochromic normocytic anaemia is common.
- Consider investigations that help rule out other conditions with similar presentations — for more information, see differential diagnosis.
- With respect to other investigations that may be carried out, note that:
- Mild abnormalities in liver function tests are common (for example raised alkaline phosphatase is present in about 30% of people).
- Serum protein electrophoresis may show increased alpha1 and alpha2 globulins.
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