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Age / Sex : 70 / F
Chief complaint: both shoulder and hip pain for 2 months
Lab: ESR 89 (n:2-20), CRP 9.57 (n:0-0.5), RA factor 15 (n:0-15)
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)
Courtesy: 서경진(Kyung Jin Suh), 동국대경주병원(Dongguk University College of Medicine Gyungju Hospital)
Diagnosis: Polymyalgia rheumatica
Discussion
Findings: Both shoulder girdles and
both hips show high signal intensity in muscles and fascia on FSE T2 fat sat
images. Also there are joint effusions in both shoulder and hip joints.
Differential Diagnosis:
Early-onset rheumatoid arthritis
Fibromyalgia
Polymyositis
Diagnosis: Polymyalgia rheumatica
Discussion:
Polymyalgia
rheumatica (PMR) is a syndrome with Inflammatory
pain and stiffness of the shoulder and/or pelvic girdles accompanied with
laboratory evidence of severe inflammation in a patient older than 50 years of
age.
There is no universally agreed upon or
thoroughly validated set of criteria for the diagnosis of PMR. In the absence
of any pathognomonic test, we use the following three criteria for the clinical
diagnosis of PMR:
1. Age 50 years or older at onset
2. Bilateral aching and morning stiffness
(lasting 30 minutes or more) persisting for at least one month, and involving
at least two of the following three areas: neck or torso, shoulders or proximal
regions of the arms, and hips or proximal aspects of the thighs
3. ESR (Westergren) elevated to 40 mm/h or
more
Some authors add a prompt response of
symptoms to corticosteroids as an additional criterion. On the other hand, the
presence of another disease to explain the findings excludes the diagnosis.
References:
1.
Soubrier M, Dubost JJ, Ristori
JM. Polymyalgia
rheumatica: diagnosis and treatment. Joint Bone Spine. 2006;73:599–605.
2.
EULAR/ACR Provisional Classification Criteria for
Polymyalgia Rheumatica.
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