Specialist referral (polymyalgia rheumatica (PMR))

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

Reference:

• (1) Dasgupta B et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology (Oxford). 2010;49(1):186-90