Polymyalgia rheumatica

Symptom Grade

Typically inflammatory girdle (shoulder and pelvic) stiffness and pain -stiffness is the main symptom -there might be associated weakness due to antalgic inhibition (in contrast to myositis)

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 (add link to this 2015  Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.)

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)

In collaboration with

Rhumato-onco taskforce KBVR/SRBR (Yves Piette, Ellen Delanghe) Gauthier Remiche, ULB Erasme
Olivier Lambotte, AP-HP, Hôpital Bicêtre, Service de Médecine
Interne et Immunologie Clinique, Paris, France,
Dimitri Psimaras, Practicien Hospitalier
Département de Neurologie Mazarin, GHPS, Paris, France



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
ESR: Erythrocyte Sedimentatio Rate
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