Hello and welcome to the Zero to Finals podcast. My name is Tom, and in this episode I'm going to be talking to you about polymyalgia rheumatica.

And you can find written notes on this topic at zero tofinals.com slash PMR or in the Rheumatology section of the second edition of the zero to finals medicine book.

So let's get straight into it.

Polymyalgia rheumatica or PMR is an inflammatory condition that causes pain and stiffness

in the shoulders, pelvic girdle and neck.

There's a strong association with giant cell arthritis,

and the two conditions often occur together. The cause of PMR is not fully understood. There are

no relevant antibodies. It is more common in older white patients. Let's talk about the presentation.

Patients may have a relatively rapid onset of symptoms, for example, over days or weeks.

Symptoms should be present for two weeks before a diagnosis is considered.

The core symptoms are pain and stiffness of the shoulders,

potentially radiating to the upper arm and the elbow,

pelvic girdle around the hips,

potentially radiating to the thighs and the neck.

The characteristic features of the pain and stiffness

are that it's worse in the morning,

worse after rest or inactivity, interferes with sleep, takes at least 45 minutes to ease in the morning,

and somewhat improves with activity.

Associated features can include systemic symptoms, for example, weight loss,

fatigue and a low-grade fever, muscle tenderness, carpal tunnel syndrome, and peripheral edema.

Let's go through the differential diagnosis.

The presenting symptoms are not specific to polymyrogyromatica,

...