Pam's diagnosis and action plan
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PMR is the most common inflammatory rheumatological disorder presenting for the first time in the over-60s. The sudden onset of Pam's problem and the rapid deterioration are typical of PMR, as is morning stiffness lasting more than 45 minutes.
You make a working diagnosis of polymyalgia rheumatica and start 15 mg prednisolone, arranging a review in a week's time.
Physiotherapy and exercise
While physiotherapy interventions haven't yet been formally investigated, it's important for patients to do gentle exercise to maintain their range of movement around their shoulders and hips. Patients report improvements in stiffness and pain as well as function.
Additional strengthening exercises can be added to a daily programme to maximise general activities of daily living and mobility.
Pam's one-week review
When Pam returns for her review, she tells you she noticed a huge improvement in her symptoms after a few days and feels almost back to normal again.
As Pam's symptoms have improved, it's appropriate to begin tapering the steroid dose. You might also want to consider the potential risk of osteoporosis – though in Pam's case, the tamoxifen she is taking may help to reduce her fracture risk.
Read more about
tapering the steroid dose and reducing the risk of side-effects. Back to Case study – Pam