criteria for dx of PMR:
pain and stiffness in two of the following areas: shoulders and upper arms, or pelvic girdle (hip and thighs), or neck and torso;
morning stiffness > 1-hr duration; duration at least 4 wk;
no muscle weakness on exam;
no other collagen-vascular disease;
elevated ESR (> 40 mm/hr);
relief of symptoms within a few d of starting low-dose steroids
Average duration 3 yr
most PMR resolves uneventfully; 5% have synovitis in sternoclavicular joints;
R/o: RA, which responds to NSAIDs whereas PMR does not.
lab: ESR > 30 mm/hr (80-95%), often > 100 mm/hr; elevated plasma viscosity and CRP (80-95%); normochromic, normocytic anemia (50-80%);
P
elevated globulin fraction in serum electrophoresis (50%); elevated alkaline phosphatase (50%); neg rheumatoid factor (85%); neg ANA (85%).
Therapeutic: PMR: Prednisone 10-20 mg/d until ESR nl, asx; ↓ 1mg/d q 4 wk; monitor ESR q 4 wk × 3 mo, then q 2-3 mo until 1 yr, then q yr (Am Fam Phys 2000;61:2000).
