Polymayalgia Rheumatica

🔴 Polymyalgia Rheumatica (PMR) 🔷 Investigations 📌 Typical inflammatory markers —ESR elevated (usually >40 mm/hr, but can be normal in 5–20%) —CRP elevated 📌 Full blood count —Normocytic normochromic anaemia —Mild thrombocytosis may occur 📌 Liver function tests —Mildly elevated ALP —Occasionally mild elevation of ALT/AST 📌 Muscle investigations —CK normal (important distinguishing feature from inflammatory myopathies) —EMG normal (not routinely required) 📌 Autoantibodies —RF negative —Anti-CCP negative —ANA usually negative     (Performed mainly to exclude rheumatoid arthritis or connective tissue disease.) 📌 Imaging 🔺 Musculoskeletal ultrasound (recommended by EULAR/ACR) -Bilateral subacromial-subdeltoid bursitis -Biceps tenosynovitis -Glenohumeral synovitis -Hip synovitis -Trochanteric bursitis 🔺 MRI if ultrasound is inconclusive FDG-PET/CT may be useful in atypical cases or suspected large-vessel vasculitis. 📌 Additional tests - Thyroid function tests (exclude hypothyroidism) - Vitamin D level - Renal profile - Bone profile - Baseline glucose/HbA1c before corticosteroid therapy -Baseline DEXA scan in patients at risk of osteoporosis or expected to require prolonged glucocorticoid therapy 🔴 Treatment A. Rapid response to low-dose prednisolone (12.5–25 mg/day) B. Relapsing or glucocorticoid-dependent disease 📌 Methotrexate is the preferred steroid-sparing agent 📌 Sarilumab (IL-6 receptor inhibitor) is an option for selected patients with recurrent or glucocorticoid-resistant PMR Courtesy: MRCP UK Dr. Muhammad Mosleh Uddin