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Polymyalgia Rheumatica

History

  • Gradual onset of pain and stiffness affecting the shoulder and pelvic girdle.
  • Age >50
  • Malaise, fever weight loss.

Examination

  • Unremarkable

Investigations

  • Routine bloods- FBC, U&E, LFT – typically normal
  • C-reactive protein and ESR – almost always elevated.
  • X-rays and other imaging – unhelpful

M.A & S.R/H.B. 15-10-24

When to refer:

  • Patient fails to respond adequately to corticosteroid therapy (suggests the diagnosis is incorrect).

Symptoms cannot be controlled with less than 10mg prednisolone daily (for consideration of immunosuppressives)

When not to refer:

  • Uncomplicated Polymyalgia Rheumatica can be managed in general practice.

How to refer:

SCI Gateway > Rheumatology > WGH