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1.09 Polymyalgia Rheumatica


Presentation

An elderly patient (more commonly female) complains of a week or two of morning stiffness, which may interfere with her ability to rise from bed, but improves during the day. She may ascribe her problem to muscle weakness or joint pains, but physical examination discloses that symmetrical pain and tenderness of neck, shoulder, and hip muscles are the actual source of any "weakness." There may be some mild arthritis of several peripheral joints, but the rest of the physical examination is negative.

What to do:

What not to do:

Discussion

Stiffness, pain, and weakness are common complaints in older patients, but polymyalgia rheumatica may respond dramatically to treatment. Rheumatoid arthritis produces morning stiffness, but is usually present in more peripheral joints, and without muscle tenderness. Polymyositis is usually characterized by increased serum muscle enzymes with a normal ESR, and may include a skin rash (dermatomyositis). Often, a therapeutic trial of prednisone helps make the diagnosis.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
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