Polymyalgia rheumatica

(JAMA 2016;315:2442; Lancet 2017;390:1700)

• Prev 7/1000 of age ≥50.
• In 50% of GCA Pts; 15% of PMR Pts develop GCA. ♀:♂ ≈ 2.
• ESR >40 mm/h (and/or ↑ CRP);

clinical manifestations

• bilateral pain & morning stiffness (>30 min),
• involving 2 of 3 areas:
  • neck or torso, shoulders or prox arms, hips or prox. thighs;
  • nighttime pain;
  • ± subdeltoid bursitis on U/S;
• exclude other causes of sx (eg, RA); nl CK

treatment

• pred 12.5–25 mg/d;
  • if clinical response,
    • initiate slow taper.
  • If not,
    • consider alternate dx or ↑ dose.
• Consider MTX if at ↑ risk of steroid side effects (Ann Rheum Dis 2015;74:1799).