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Polymyalgia rheumatica


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Polymyalgia rheumatica

  2. 2. is a clinical syndrome characterized by severe aching and stiffness in the neck, shoulder girdle, and pelvic girdle.
  3. 3. Pathophysiology    causes severe pain in the proximal muscle groups; however, no evidence of disease is present at muscle biopsy. Muscle strength and electromyographic findings are normal.  cell-mediated injury to the elastic lamina in the blood vessels in the affected muscle groups.
  4. 4. Incidence     Frequency 1 in 200 people aged 50 years or older. Mortality/Morbidity not a life-threatening disease, but it does require treatment for 2-4 years. Race whites >other ethnic groups Sex Females are affected twice as often as males.
  5. 5. Symptoms         Pain and stiffness in the proximal muscle groups that usually is symmetrical and worse in the morning. Gel phenomenon (stiffness after prolonged inactivity). Fever (low grade). Weight loss. Fatigue. Depression. No weakness. Abrupt onset of symptoms.
  6. 6. Signs    No muscle atrophy. Muscle tenderness. Decreased active range of motion of joints secondary to pain.
  7. 7. Lab studies     Erythrocyte sedimentation rate greater than 50 mm/h Normochromic normocytic anemia in 50% of cases Normal creatinine kinase level Negative finding for rheumatoid factor    Mild elevations with liver function test results Mild nonspecific synovitis Negative muscle biopsy findings
  8. 8. Treatment  Corticosteroids e.g. prednisone 5-60 mg/d PO qd or divided bid/qid; taper over 2 wk as symptoms resolve.
  9. 9. Prognosis    The average length of disease is 3 years. Exacerbations may occur if steroids are tapered too rapidly. Relapse is common.