INVESTIGATIONS & DIAGNOSIS, TREATMENT PLAN PMR

INVESTIGATIONS & DIAGNOSIS

PMR: – ESR

• CRP

GCA(blood tests should not delay treatment):

• ESR – CRP
• FBC
• Secondary care: ultrasound, biopsies of temporal aa

TREATMENT PLAN PMR

Management:

• Prednisolone 15mg OD for 7 days, review
• Continue 15mg OD for 3-4 weeks
• Taper: 12.5mg for 3 weeks, 10mg for 4-6 weeks, reduce by 1mg every 4-8 weeks          –

Monitoring: check at 1 week after the first dose change, then 3 months in the first   year  – Monitor: blood glucose, BP, ESR, CRP  GCA Management:

• Visual symptoms: same-day ophthalmology assessment
• Immediate prednisolone if visual symptoms
• Non-visual symptoms: rapid rheumatology referral (<3 days)
• Prednisolone 40-60mg
• Treatment duration: 1-2 years – Steroid card required
• Reviews (Monitor blood glucose & BP): every 2-8 weeks (first 6 months), every 12      weeks (next 6 months), every 12-24 weeks thereafter

Relapse Management:

Without ischemic changes: Restart High dose of steroids

• With ischemic changes: High-dose steroids + specialist input
• With Visual symptoms: High-dose steroids + MTX.