Musculoskeletal manifestations are the commonest presentation of polymyalgia rheumatica.
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Epidemiology
Polymyalgia rheumatica is the most common inflammatory rheumatic condition in older adults 1.
Associations
Clinical presentation
Patients typically present with 1:
shoulder or pelvic girdle aches lasting over 2 weeks
morning shoulder or pelvic girdle stiffness
raised inflammatory markers (e.g. ESR)
Radiographic features
Plain radiograph
Features of polymyalgia rheumatica are not typically visible on plain radiograph 5. Arthritis, if present, is non-erosive. Nevertheless, radiographs are useful to exclude other differential diagnoses of arthropathy.
Ultrasound
Although usually not required, ultrasound may commonly show 2:
biceps long head tenosynovitis
MRI
MRI typically shows synovitis and extra-articular manifestations such as enthesitis, bursitis, or tenosynovitis. Myofascial inflammation may also be seen. Gadolinium-enhanced sequences characteristically show peritendinous enhancement 5.
Nuclear medicine
FDG PET-CT
Several characteristic areas of hypermetabolic activity are seen on FDG PET-CT which likely reflect bursitis, synovitis, or tenosynovitis. Characteristic locations of hypermetabolic activity include the shoulder joints, sternoclavicular joints, interspinous regions, hip joints, prepubic regions, ischial tuberosities, and knee joints 3,4. Smaller joints of the wrist and hand are less commonly affected 3.
Treatment and prognosis
Treatment is usually low dose corticosteroids which most patients respond well to 1.