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PMR Response Assessment — SCE Rheumatology MCQ

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EasyVasculitisPMR Response AssessmentSCE Rheumatology

A 55-year-old woman with PMR responds dramatically to Prednisolone 15 mg daily with complete symptom resolution within 72 hours. At what point should a lack of dramatic response prompt reconsideration of the PMR diagnosis?

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Correct answer: D — If there is no significant improvement (>70%) within 1 week of starting appropriate-dose Prednisolone the diagnosis of PMR should be reconsidered

A hallmark of PMR is the dramatic and rapid response to moderate-dose glucocorticoids (12.5-25 mg Prednisolone). BSR 2010 PMR guidelines and ACR/EULAR 2012 PMR criteria include treatment response as a supportive feature. If there is no significant improvement (>70%) within 1 week alternative diagnoses should be actively considered: late-onset RA malignancy (particularly myeloma lymphoma solid tumours) infection inflammatory myopathy hypothyroidism and GCA. Failure to respond should trigger re-evaluation with appropriate investigations rather than simply increasing the steroid dose.

Reference: BSR 2010 PMR guidelines; Dasgupta B et al 2012 ACR/EULAR PMR criteria