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Polymyalgia Rheumatica

Clinical Characteristics of Polymyalgia Rheumatica

    The Docken criteria:

      Older adult

      Abrupt onset

      AM stiffness

      Proximal polyarthralgias: upper arms, thighs, neck

      Seronegative

      ESR usually elevated

      Brisk response to low dose steroids

      Not erosive

Epidemiology

    Whites > Polymyalgia Rheumatica blacks, Asian; seven times more common in whites than blacks

    Females > Males

    > 50 years old. Mean age of onset approx. 70 years; range 50-90 polymyalgia rheumatica, polymialgia, rumatica

    Incidence: 52.5/100,000Icon

    A common problem in the elderlyIcon

    Occasional familial casesIcon

PathophysiologyIcon

    Muscle is normal:Icon

      Normal enzymesIcon

      Normal EMGIcon

      Essentially normal biopsyIcon

      Myopathies usually don't hurt; arthropathies often do. Myopathies usually present with painless weakness.Icon

    PMR is an arthritis:Icon

      AM stiffness is common and is a cardinal clinical feature of many systemic rheumatic diseasesIcon

        Hip and shoulder arthritis often results in referred pain to the thighs and upper arms, respectivelyIcon

        muscle tenderness to direct palpation is an unreliable physical signIcon

      Carpal tunnel syndromes are commonIcon

      Direct evidence for synovitisIcon

        Physical examination reveals sinovitisIcon

        Synovial fluid analysis (synovial fluid wbc is variable, up to 21,000 cells/cc)Icon

          Arthroscopy - Evidence for synovitis at the shoulder; mild to moderate synovial proliferation and chronic inflammation, generally less polymyalgia rheumatica , polymialgia, rumatica