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.
Explore this issueNovember 2018
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.
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.