Polymyalgia rheumatica (musculoskeletal manifestations)

Last revised by Mostafa El-Feky on 19 Jul 2023

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

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

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)

Although usually not required ultrasound may commonly show 2:

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 is usually low dose corticosteroids which most patients respond well to 1

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