Rheumatoid Arthritis vs Polymyalgia Rheumatica
Rheumatoid Arthritis and Polymyalgia Rheumatica are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Rheumatoid Arthritis vs Polymyalgia Rheumatica at a glance
- Rheumatoid Arthritis: Chronic symmetric inflammatory polyarthritis with autoantibodies and erosive joint damage.
- Polymyalgia Rheumatica: Inflammatory syndrome of shoulder and hip girdle stiffness in adults over 50; dramatic response to low-dose steroids.
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Side-by-side comparison
| Feature | Rheumatoid Arthritis | Polymyalgia Rheumatica |
|---|---|---|
| At a glance | Chronic symmetric inflammatory polyarthritis with autoantibodies and erosive joint damage. | Inflammatory syndrome of shoulder and hip girdle stiffness in adults over 50; dramatic response to low-dose steroids. |
| Classic presentation | Symmetric MCP/PIP/wrist swelling with positive MCP/MTP squeeze test, plus rheumatoid nodules in seropositive disease.; Insidious symmetric polyarthritis of… | Subacute onset of bilateral shoulder and hip girdle aching and stiffness; Morning stiffness >45 minutes (often hours); Difficulty rising from a chair or… |
| Workup / key labs | 2010 ACR/EULAR classification: score ≥6 of 10 across (a) joint involvement, (b) serology (RF/anti-CCP), (c) acute-phase reactants, and (d) symptom duration ≥6… | 2012 EULAR/ACR provisional criteria: age ≥50, bilateral shoulder pain, abnormal CRP or ESR, plus weighted morning stiffness, hip involvement, absence of other… |
| Imaging | Plain radiographs of hands and feet — periarticular osteopenia, symmetric joint-space narrowing, marginal erosions (MTPs often earliest); Ultrasound or MRI —… | Shoulder ultrasound or MRI — subacromial-subdeltoid bursitis, biceps tenosynovitis, glenohumeral synovitis (supportive but not required); Temporal artery… |
| First-line treatment | Early DMARD therapy within 3 months of diagnosis — methotrexate is anchor drug; start 10-15 mg PO/SC weekly with folic acid 1 mg daily; Conventional DMARDs —… | Prednisone 12.5-25 mg/day — dramatic improvement within 48-72 hours is both therapeutic and diagnostic; Slow taper over 1-2 years guided by symptoms and… |
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