Polymyalgia rheumatica - what's new?

Ultrasound, MRI and PET-CT reveal a typical anatomical distribution of inflammation in the shoulder and pelvic girdle. MRI and PET-CT may additionally show inflammation along the spine. New classification criteria include age 50 years, elevated CRP and / or ESR, and shoulder girdle pain as well as two alternative algorithms with or without ultrasound. The algorithm with ultrasound is more specific but equally sensitive than the other algorithm. According to new recommendations on management diagnosis should be definitely established. Lab tests need to be considered as well as comorbidities. A starting dose of 12.5-25 mg / d prednisone - equivalent is recommended, followed by a dose reduction to 10 mg / d within 4-8 weeks. Afterwards the dose should be reduced by 1 mg every 4 weeks. Methotrexate might be added in patients with significant risks and comorbidities. Follow-up visits should occur every 4-8 weeks during the first year.