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Referring patients with PMR

Back to Hip and shoulder pain in older adults – PMR

Many patients with suspected PMR can be safely diagnosed and managed in general practice but patients should be referred if:

  • there's uncertainty about the diagnosis
  • they're not responding to standard primary care treatment.

The British Society for Rheumatology (BSR) recommends referral in the following situations:

  • age <60
  • no shoulder involvement
  • no inflammatory stiffness
  • insidious onset
  • normal or very high inflammatory markers
  • presence of 'red flag' features (e.g. prominent systemic features, weight loss, night pain, neurological signs)
  • suspicion of co-existing giant cell arteritis (GCA)
  • poor or incomplete response to glucocorticoids
  • difficulty reducing the steroid dose
  • recurrent relapses
  • contraindication to glucocorticoids.
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Back to Hip and shoulder pain in older adults – PMR

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