Polymyalgia rheumatica

Management escalation pathway

  • Diagnosis and treatment (corticoid therapy) can be done by oncologist/GP except when diagnosis is not clear or when there is lack of respons to corticoids (which suggests an alternative diagnosis)
  • Corticoid treatment: 20 mg predni and tapering over 9-12 months (https://www.ncbi.nlm.nih.gov/pubmed/26352874)

Assessment and Investigations

  • Blood sample: often elevated ESR/CRP (should be done before starting corticoids); CKs should be normal (in contrast to myositis)
  • Check for symptoms of giant cell arteritis in order to avoid sudden blindness (discuss temporal artery biopsy with rheumatologist/internist)


ACPA: Anti Citrullinated Antibody
ANF: Anti Nuclear Factor
C3/C4: Complement Factor 3 or 4
CK: Creatine Kinase
CK MB: Creatine Kinase Muscle
ECG: ElectroCardioGram
EMG: ElectroMyoGram
ICPi: Immune Checkpoint Blockade Inhibition
MRI: Magnetic Resonance Imaging
PD: Per Day
PO: Per Os
Pro-BNP: Pro-Brain Natriuretic Peptide
RF: Rheuma Factor
ULN: Upper Limit of Normal