Polymyalgia rheumatica (musculoskeletal manifestations)

Musculoskeletal manifestations of polymyalgia rheumatica are the commonest presentation of polymyalgia rheumatica.

Epidemiology

Polymyalgia rheumatica is the most common inflammatory rheumatic condition in older adults ¹.

Associations

• giant cell arteritis

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

Ultrasound

Although usually not required ultrasound may commonly show ²:

• bilateral subacromial bursitis

• biceps long head tenosynovitis

• trochanteric bursitis

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.