Snapshot A 50-year-old woman presents to her physician's office for muscle pain and stiffness in the morning. She reports that this has been going on for a few months now and has been getting increasingly more painful. As a hair stylist, she reports that she now has to schedule her appointments in the afternoon, as her muscles are too stiff and sore to cut and style hair. She also reports that she occasionally gets low-grade fever with no other signs of infection. Physical exam reveals normal strength and slightly reduced range of movement. Laboratory exam reveals elevated erythrocyte sedimentation rate and C-reactive protein. Serum rheumatoid factor and antinuclear antibodies are normal. She is given systemic low-dose corticosteroids. Introduction Clinical definition chronic and inflammatory rheumatic disease characterized by muscle pain and stiffness Epidemiology demographics female > male > 50 years of age risk factors winter months viral infections Pathogenesis pathogenesis is unclear but may be triggered by environmental factors such as winter or viral infections and inflammatory cytokines play a key role Associated conditions giant cell arteritis (in ~20% of patients) Prognosis ~50% of patients experience relapse Presentation Symptoms muscle pain and stiffness in the neck, shoulders, or pelvis for > 2 weeks stiffness is more prominent in the morning difficulty rising out of chair or lifting arms above head constitutional symptoms fatigue low-grade fevers weight loss headache may indicate giant cell arteritis Physical exam normal muscle strength may have reduced active and passive range of movement joint swelling may be appreciated Studies Labs ↑ inflammatory markers erythrocyte sedimentation rate C-reactive protein normal creatine kinase autoantibodies typically absent Making the diagnosis based on clinical presentation and laboratory studies Differential Rheumatoid arthritis Spondyloarthropathy Adhesive capsulitis Fibromylagia Treatment Management approach if patients do not rapidly respond to low-dose corticosteroids, consider an alternative diagnosis nonsteroidal anti-inflammatory drugs usually do not have any effect Medical systemic low-dose corticosteroids indications initial therapy for patients with polymyalgia rheumatica low-dose steroid response is usually rapid consider supplementing with calcium and vitamin D for prevention of osteoporosis methotrexate indications added to treatment regimen for patients on prolonged therapy, with inadequate response to steroids used in patients in whom steroids are contraindicated Complications Blindness caused by giant cell arteritis
QUESTIONS 1 of 1 1 Previous Next (M1.MK.14.23) A 65-year-old woman comes to clinic complaining of pain with chewing solid foods. She reports that she has been feeling unwell lately, with pains in her shoulders and hips, and she has lost five pounds in the past few months. Her vital signs are T 39C, RR 18 breaths/min, HR 95 bpm, BP 120/65 mmHg. When you ask her to stand from her chair to get on the exam table she moves stiffly but displays preserved proximal muscle strength. Another potential symptom or sign of this disease could be: Tested Concept QID: 101687 Type & Select Correct Answer 1 Violaceous rash across the eyelids 14% (3/22) 2 Blindness 27% (6/22) 3 Easily sunburned on face and hands 9% (2/22) 4 Hemoptysis 5% (1/22) 5 Thickened, tight skin on the fingers 45% (10/22) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept