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Polymyalgia Rheumatica

Matthew DeLaney, MD and Jeff Holmes, MD
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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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Phil -

Great discussion thanks guys. You stated that about 20% of PMR patients have increase risk of stroke and MI and we are considering this diagnosis when there is an elderly fall, is there any other type of medication that will help other than steroids considering their side effects (increase risk of venous thrombus, increase risk of fracture) while we are working them up for PMR? Do we just accept those SE since the benefit outweighs those risk?

Thanks

Mike W., MD -

From Matt DeLaney:
Phil, that's a great question. Unfortunately there aren't really any other medications that would give patients the potential benefits offered by steroids. As we've talked about before, there are plenty of potential issues related to steroid use and for me the decision to use these is always made on a case by case basis. If the patient has a story and exam that make it seem like they have a high pre-test likelihood of having PMR I'm more likely to use steroids and try to anticipate the potential side effects. Alternatively for a patient who just had a fall and doesn't really have many other signs to suggest they have underlying PMR I am less likely to expose them to all the potential downsides associated with steroids.

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Breaking Bad - Insulin Pumps and Mandibles Full episode audio for MD edition 199:17 min - 93 MB - M4AUrgent Care RAP - November 2018 Written Summary 671 KB - PDF

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