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For more information, go to www.arthritisresearchuk.org

Summary and further reading

Back to Hip and shoulder pain in older adults – PMR

This module and the accompanying case studies demonstrate that an initial diagnosis of PMR should be kept under regular review:

  1. to monitor response to treatment
  2. to re-consider the diagnosis where appropriate
  3. to check for possible side-effects of treatment
  4. to remain vigilant for 'red flag' symptoms.

Key points:

  • Don't start treatment with glucocorticoids until you've done appropriate investigations to rule out other disorders.
  • Don't miss giant cell arteritis (GCA).
  • Most patients with PMR can be safely managed in primary care but you should have a low threshold for referral in cases of diagnostic uncertainty or inadequate response to treatment.
  • Patient education is essential and should include information on potential treatment side-effects and on the symptoms of GCA.
  • Assess for comorbidities and for potential treatment risks and side-effects during each patient review.

References

  • Smeeth L, Cook C, Hall AJ. Incidence of diagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom, 1990-2001. Ann Rheum Dis 2006 Aug;65(8):1093–98.
  • Crowson CS, Matteson EL, Myasoedova E, Michet CJ, Ernste FC, Warrington KJ, et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis Rheum 2011 Mar;63(3):633–39.
  • Helliwell T, Hider S, Mallen S. Polymyalgia rheumatica: Diagnosis, prescribing and monitoring in primary care. Br J General Prac 2013 May;63(610):e361–66.
  • Dasgupta B, Borg FA, Hassan N, Barraclough K, Bourke B, Fulcher J, et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology (Oxford) 2010 Jan;49(1):186-90.
  • Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C, et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2012 Apr;71(4):484–92. 

Further reading and useful resources

  • Helliwell T, Hider S, Barraclough K, Dasgupta B, Mallen C. Diagnosis and management of polymyalgia rheumatica. Br J Gen Prac 2012 May;62(598):275–26.
  • Barraclough K, Mallen C, Helliwell T, Hider S, Dasgupta K. Diagnosis and management of giant cell arteritis. Br J Gen Prac 2012 Jun;62(599):329–30.
  • NICE Clinical Knowledge Summary 
    http://cks.nice.org.uk/polymyalgia-rheumatica#!topicsummary
  • Concise Guideline (Royal College of General Practitioners) 
    www.rcplondon.ac.uk/resources/concise-guidelines-diagnosis-and-management-polymyalgia-rheumatica
  • Systematic Review Treatment of Polymyalgia Rheumatica. A Systematic Review. J Hernández-Rodríguez, M Cid, A López-Soto, G Espigol-Frigolé, X Bosch. Arch Intern Med 2009; 169: 1839–50. 
    http://archinte.jamanetwork.com/article.aspx?articleid=1108564
  • Review Our approach to the diagnosis and treatment of polymyalgia rheumatica and giant cell (temporal) arteritis V Quick and J Kirwan J R Coll Physicians Edinb 2012; 42: 341–49.
  • Review of imaging Imaging of polymyalgia rheumatica: indications on its pathogenesis, diagnosis and prognosis. D Camellino, A Marco. Rheumatology 2012; 51; 77–86.
  • Review Advances and challenges in the diagnosis and treatment of polymyalgia rheumatica. TA Kermani and K Warrington. Ther Adv Musculoskel Dis 2014; 6: 8–19.
    www.ncbi.nlm.nih.gov/pmc/articles/PMC3897167/
  • Case vignette Giant-Cell Arteritis and Polymyalgia Rheumatica CM Weyand and J Goronzy. N Engl J Med 2014; 371: 50–57.
  • CME Rheumatology. Polymyalgia rheumatica: pathogenesis and management. S Mackie. Clinical Medicine 2013; 13: 398–400.
  • PatientPlus (for Healthcare professionals)
  • NHS choices 
    www.nhs.uk/conditions/Polymyalgia-rheumatica/Pages/Introduction.aspx

Patient resources

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Back to Hip and shoulder pain in older adults – PMR
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