Diagnostic Tests For Polymyalgia Rheumatica

One typical characteristic is a very high sedimentation rate and an elevated C-reactive protein in the patient's blood. A surface antigen that can be measured with special tests on the surface of white blood cells called HLA-DR4 is found frequently in these patients. An elevated alkaline phosphatase is found in many cases, which alternatively can be measured.

There may be an anemia, which can be measured in the blood of these patients. In research laboratories there may be more fancy tests such as looking for specialized T cell lymphocytes, called CD4 lymphocytes, which are immune cells specifically directed at the elastic membrane in the arterial walls of the cranial arteries in the case of giant cell arteritis.

The following table suggests tests that can be done to rule out other causes of muscle pains (from data of Ref. 1 and 2).

Tests to exclude other causes than polymyalgia rheumatica and temporal arteritis
Tests:	Comments:
ESR (erythrocyte sedimentation rate)	very sensitive, but non specific. Also elevated in RA, SLE and infections
C-reactive protein	more specific, but also positive in other rheumatic illnesses.
TSH	to rule out hypothyroidism
monoclonal antibodies	to rule out multiple myeloma
EMG studies and muscle biopsy	positive in polymyositis, negative in polymyalgia rheumatica
temporal artery biopsy	can confirm giant cell arteritis histologically, but is negative in 33%!
CK (creatinine kinase)	this muscle enzyme is elevated in the blood with polymyositis, but not with polymyalgia rheumatica

Apart from these diseases mentioned here there are more rare other forms that your physician may want to rule out before diagnosing polymyalgia rheumatica.

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Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 14.

2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 50.

6. B. Sears: "The age-free zone".Regan Books, Harper Collins, 2000.

7. B. Sears: "Zone perfect meals in minutes". Regan Books, Harper Collins, 1997.

Last Modified: Feb. 2, 2007