Polymyalgia rheumatica
Summary
Definition
History and exam
Key diagnostic factors
- shoulder/hip girdle stiffness
- shoulder/hip girdle pain
- rapid response to corticosteroids
Other diagnostic factors
- acute onset
- low-grade fever
- anorexia
- weight loss
- malaise
- depression
- asthenia
- oligoarticular arthritis
Risk factors
- age ≥50 years
- giant cell arteritis (GCA)
- female sex
Diagnostic investigations
1st investigations to order
- erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- CBC
Investigations to consider
- TSH
- ultrasound
- MRI
- serum protein electrophoresis
- serum creatine phosphokinase
- rheumatoid factor
- anti-cyclic citrullinated peptide antibodies
Emerging tests
- interleukin (IL)-6
- fluorodeoxyglucose F-18 PET scan
Treatment algorithm
initial presentation
treatment-resistant or relapse or disease exacerbation
Contributors
Authors
Ari Weinreb, MD, PhD
Associate Chief of Rheumatology
VA Greater Los Angeles Healthcare System
Associate Clinical Professor of Medicine
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
AW declares that he has no competing interests.
Acknowledgements
Dr Ari Weinreb would like to gratefully acknowledge Dr Lynell Newmarch, a previous contributor to this topic.
Disclosures
LN declares that she has no competing interests.
Peer reviewers
Brian F. Mandell, MD, PhD, FACR
Vice Chairman of Medicine for Education
Professor of Medicine
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
Editor in Chief
Cleveland Clinic Journal of Medicine
Cleveland Clinic
Cleveland
OH
利益声明
BFM declares that he has no competing interests.
Kuntal Chakravarty, FRCP (London), FRCP (Glasgow), FRCP (Ireland), FACP (USA), FACR (USA)
Consultant Rheumatologist
BHRT University Hospital
Queen’s Hospital
Romford
UK
利益声明
KC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Nothnagl T, Leeb BF. Diagnosis, differential diagnosis and treatment of polymyalgia rheumatica. Drugs Aging. 2006;23:391-402. 摘要
Buttgereit F, Dejaco C, Matteson EL, et al. Polymyalgia rheumatica and giant cell arteritis: A systematic review. JAMA. 2016 Jun 14;315(22):2442-58. 摘要
Dejaco C, Singh YP, Perel P, et al; European League Against Rheumatism; American College of Rheumatology. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheumatol. 2015;67:2569-2580.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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