Data gathering
- Red flags – headaches, visual changes, jaw pain, weight loss
- Others – worse in the mornings, bilateral shoulder and hip pain
- Examine – neck, shoulders, hips, temporal arteries
Clinical management
- Investigations
- Bloods – ESR
- Explanation
- PMR is a condition where there is irritation of the large muscles of the body leading to pain and stiffness – symptoms typically develop gradually – a steroid medicine helps ease symptoms and is needed for several months to years
- Treatment
- Prednisolone – 15mg OD, reduce slowly to maintenance dose of 5mg (over 1-2 years)
- Steroid card – details dose, indication, informs drs to continue
- Consider osteoporosis prophylaxis
- Follow-up / Safety net
- if headaches, visual changes – see dr urgently
- see in 2 weeks for response to steroids
NB:
- When starting steroids, check:
- DM, mental health, BP, weight