referral criteria from primary care (polymyalgia rheumatica)

Last reviewed 05/2021

This condition is normally managed satisfactorily in primary care.

Early specialist 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