The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Case Report: The Hairdresser Who Couldn’t Comb Hair

Case Report: The Hairdresser Who Couldn’t Comb Hair

November 19, 2018 • By Erin Hammett, DO, & Edward Skol, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF
MOLEKUUL / Science Source

MOLEKUUL / Science Source

Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition characterized by pain and morning stiffness at the neck, shoulders and hip girdle. It can be associated with giant cell arteritis (GCA); in fact, the two disorders may represent a continuum of the same disease process. This case describes a patient who initially refused treatment for PMR and eventually developed GCA, resulting in multiple complications and requiring four hospitalizations over a yearlong period.

You Might Also Like
  • Fellow’s Forum Case Report: Takayasu’s Arteritis
  • Polymyalgia Rheumatica
  • Higher Fracture Risk in Patients with Polymyalgia Rheumatica, Giant-Cell Arteritis
Explore This Issue
November 2018

The Case

A 79-year-old woman presented to her primary care physician’s office for an annual physical. She described a four-month history of widespread pain, proximal muscle weakness and morning stiffness, most prominent in the neck and shoulders. These symptoms made her work as a hairdresser extremely difficult. Labs showed a normal creatine kinase (CK) of 53 units/L (normal range: 26–192 units/L), an elevated erythrocyte sedimentation rate (ESR) of 58 mm/hr (normal range: <30 mm/hr) and an elevated C-reactive protein (CRP) of 14.2 mg/L (normal range: <10 mg/L). She was then referred to our rheumatology clinic for suspected PMR.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

At her initial visit with us, she complained of weakness in her bilateral shoulders, thighs and calves, all worse in the morning and improved with activity. She was unable to lift her arms above her shoulders due to pain and stiffness, and had a difficult time getting up from a seated position. She denied fevers, chills, night sweats, anorexia, weight loss, rash, headaches, vision changes, jaw pain/claudication, scalp tenderness or joint swelling.

Her medical history was notable for breast cancer, which was now in remission, asthma, irritable bowel syndrome and hyperlipidemia with a history of statin intolerance. Medications included a fluticasone inhaler twice daily, an albuterol inhaler as needed, and calcium and vitamin D supplements.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

She had no family history of autoimmune disease, PMR or vasculitis. Her social history was significant for three to four years of smoking in her 20s and occasional alcohol use. The physical exam was normal, except for limited active abduction of the shoulders.

The patient was advised to start 15 mg of prednisone daily for a suspected diagnosis of PMR, but she refused. She expressed apprehension of taking any prescription medications and was adamant she wanted to “control the inflammation with dietary changes.”

The patient was warned that approximately 15% of patients with PMR develop GCA, which could potentially lead to permanent blindness.1 She was instructed to call our office if she changed her mind regarding starting the prednisone. She was educated about symptoms suggestive of GCA, and was instructed to contact us if she developed any such new symptoms.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Pages: 1 2 3 4 5 6 | Single Page

Filed Under: Conditions, Vasculitis Tagged With: abatacept, case report, Giant Cell Arteritis, lithium, Methotrexate, Polymyalgia Rheumatica, Steroids, tocilizumabIssue: November 2018

You Might Also Like:
  • Fellow’s Forum Case Report: Takayasu’s Arteritis
  • Polymyalgia Rheumatica
  • Higher Fracture Risk in Patients with Polymyalgia Rheumatica, Giant-Cell Arteritis
  • Trial Data Reveals the Limitations of Steroids in Giant Cell Arteritis Therapy

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2022 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.