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Internal Medicine

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A 74-year-old woman reports fever of two weeks duration. She has also noted morning stiffness that lasts at least one-half hour along with pain in both shoulders. Her shoulder pain is worsened by movement and interferes with her sleep. She saw a new internist two months ago who started her on a statin for increased lipids.

On exam, she has decreased active and passive motion of the shoulders. There is no obvious joint swelling and her muscles are not tender on palpation. There is a mild, normochromic normocytic anemia; WBC count is normal. Sedimentation rate is 104 mm/hr and C-reactive protein is five times the upper limit of normal.

Which one of the following is the most likely diagnosis?

  • Adult Still's disease

  • Polymyalgia rheumatica

  • Statin toxicity

  • Rheumatoid arthritis

Nader Guma
١٨ مايو

Polymyalgia rheumatica should be suspected in older patients with bilateral shoulder and hip stiffness that is worse in the morning and improves with use. An array of nonspecific musculoskeletal complaints, constitutional symptoms, and elevated serum inflammatory markers may be present

Polymyalgia rheumatica shares many symptoms with a range of other diseases, including:

• rheumatoid arthritis (RA)

• tendonitis or bursitis.

• infections.

• fibromyalgia.

• Lyme disease.

• spondyloarthropathy.

• lupus.

• vasculitis.

use of a statin might be associated with the occurrence of PMR. It has also been reported that statins may induce neo- antigens as a result of muscle damage that are subsequently presented to the immune system.

Patients should be evaluated at diagnosis and periodically for the development of giant cell arteritis.

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