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Polymyalgia Rheumatica

Jeff Holmes, MD and Matthieu DeClerck, MD
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12:30
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Matt Delaney interviews Jeff Holmes MD to discuss polymyalgia rheumatica. PMR should be suspected in patients over 50 with symptoms involving aching and stiffness about the upper arms, posterior neck, pelvic girdle, and/or lumbar region (all worse upon arising in morning). Jeff and Matt discuss pathophysiology, diagnosis and treatment of this condition.

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Kaitlyn W. -

Am I missing something? I got Q10 wrong... I chose order ESR and CRP, but the correct answer is Hepatic Function Panel. I think I missed something?

Neda F., MD -

Hi Kaitlyn. We're looking into it now! Thanks for letting us know. -- Neda

Neda F., MD -

It's fixed now. Thanks so much for letting us know about the mixup. -- Neda

Megan B., PA -

Questions of prognosis:
This is described as a chronic condition. What is the typical time course? How frequently do people relapse and need steroids again? Do some need continuous low dose steroids chronically?

Neda F., MD -

Hi Megan. I'll share what Up to Date says, and then some articles on this issue.

From UTD: "In most patients, PMR runs a self-limited course, and glucocorticoids can eventually be discontinued. In about one-half of patients, treatment can be stopped after one to two years. Other patients require continuation of prednisone for longer periods of time, commonly at stable doses of 5 mg/day or less. At one center, the median duration of some glucocorticoid therapy was 37 months. Another study found that one-third of patients required management with glucocorticoids for more than six years. Clinical inertia likely accounts for a protracted course of low-dose glucocorticoid treatment in some patients.

Practically, there appear to be two broad subgroups of PMR. In one, glucocorticoids can be rather uneventfully tapered off over a year or two, while in another, a relapsing course requires longer treatment."

Here are the articles:
https://www.ncbi.nlm.nih.gov/pubmed?term=24129145
https://www.ncbi.nlm.nih.gov/pubmed?term=4036982
https://www.ncbi.nlm.nih.gov/pubmed?term=18578959

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Into Thin Hair Full episode audio for MD edition 195:41 min - 92 MB - M4APC RAP February 2019 Written Summary 406 KB - PDF

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