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Polymyalgia rheumatica - Management
When should I refer?
- Consider referring all people with suspected polymyalgia rheumatica to rheumatology for confirmation of the diagnosis.
- Refer early to a rheumatologist if there are:
- Atypical features or features that increase likelihood of an alternative diagnosis, such as:
- The person is younger than 60 years of age.
- Insidious onset.
- Lack of shoulder involvement.
- Lack of morning stiffness.
- Red flag features, such as prominent systemic features, weight loss, night pain, neurological signs.
- Peripheral arthritis or other features of rheumatic disease.
- Normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), or very high ESR and CRP.
- Treatment dilemmas, such as:
- Incomplete or non-response to corticosteroids.
- Poorly-sustained response to corticosteroids.
- Being unable to reduce corticosteroids.
- Frequent relapses.
- Contraindications to corticosteroids. For more information, see the CKS topic Corticosteroids - oral.
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