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Referral criteria from primary care (polymyalgia rheumatica)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

This condition is normally managed satisfactorily in primary care.

Earlyspecialist referral is recommended for:

  • patients with atypical features or features that increase likelihood of a non-PMR diagnosis:
    • younger patient < 60 years
    • chronic onset
    • lack of shoulder involvement
    • lack of inflammatory stiffness
    • ‘Red flag’ features: prominent systemic features, weight loss, night pain, neurological signs
    • peripheral arthritis or other features of CTD/ muscle disease
    • normal or very high ESR/CRP
  • or treatment dilemmas such as:
    • incomplete or non-response to corticosteroids
    • ill-sustained response
    • unable to reduce corticosteroid dose
    • need for prolonged corticosteroid therapy (longer than two years)
    • contra-indications to corticosteroid therapy


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