Araújo, R

Cabral, C

Gonçalves, A

Lages, A

English

Institutional repository of Hospital de Braga

Polymyalgia rheumatica - always to be kept in mind Catia Cabral, Ana Lages, Rosário Araújo, António Gonçalves Department of Internal Medicina, Hospital de Braga, Portugal Introduction: Polymyalgia rheumatica (PMR) is an inflammatory disorder characterized by pain, aching and morning stiffness in the shoulder girdle and often in the pelvic girdle and neck. It almost exclusively affect patients aged 50 years or over, with an approximately 2–3:1 male to female ratio.  A systemic inflammatory response and a marked response to corticosteroid therapy are typical features of PMR. Giant cell arteritis (GCA) occurs together more frequently than expected by chance alone.  Purpose: Consider alternative diagnosis in the very elderly with apparent neurological symptoms.  •Presentation: A ninety years old lady, without major disease burden was admitted to our department for a lower respiratory tract infection, prostration and tremor at rest. •Methods:During her stay she developed myalgia and stiffness of the shoulder girdle and neck associated with a resting tremor. •A diagnosis of Parkinson’s disease was admitted and she was submitted to a therapeutic proof with L-DOPA without improvement.  •By keeping, after two weeks, myalgias with inflammatory pattern, the hypothesis of polymyalgia rheumatica was considered . •Results: Brain CT scan was irrelevant. Considering the inflammatory pattern of the myalgia with negative rheumatoid factor, ANCA, ANA of 1/80, normal CK and ESR of 101 mm/h a diagnosis of PMR was considered. Biopsy of the temporal artery discarded atrophy of giant cells. •She started prednisolone 10 mg/day with complete resolution of the clinical picture. Conclusion: In the very elderly is easy to focus in one symptom that fits with a neurological condition. Nonetheless it leads to unnecessary exams and delayed diagnosis and proper treatment. We must be alert to all symptoms and consider diagnosis that are not so expected in this age group.  Focus of condensation in the right hemithorax   Ischemic leukoencephalopathy, translated by hypodense periventricular white matter, extending to the subcortical white matter and external capsule. 

Polymyalgia rheumatica - always to be kept in mind

http://repositorio.hospitaldebraga.pt/bitstream/10400.23/605/1/Polimialgia%20reumatica%20europeu%202014.pdf

Polymyalgia rheumatica - always to be kept in mind

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Institutional repository of Hospital de Braga