Polymyalgia Rheumatica

Cold Shoulder

Step 1: View clinicals

A 64 year old women presents with pain and stiffness in both shoulder girdles for 3 months. These symptoms are present upon waking up, and last for a couple of hours before gradually subsiding. She noticed that the stiffness tends to decrease with gentle activity, and is increased by prolonged rest. She also complains of gradual loss of weight during this time, and of constantly feeling fatigued. Her medical history is unremarkable, and she is not on any drugs. X-rays of both shoulders appear to be normal.


Step 2: Order all relevant investigations

ESR + CRP

ESR: 82 mm/1h (<20) CRP: 15 mg/dL (0-1.0 mg/dL)

CPK

Serum CPK: 70 U/L (22-198)

Full Blood Count

WBC/DC: 8,000/mm3 (4,500-11,000) Hb: 14.0 g/dL (11 - 18) Platelets: 380,000/mm3 (150,000 - 400,000)

Autoantibody Screen

ANA: negative ds-DNA: negative Rheumatoid Factor: negative Anti-CPA: negative


Step 3: Select appropriate management

Corticosteroids
Analgesics
Anti-TNF agents
Vitamin D & Calcium


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