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Polymyalgia rheumatica - Management
What else might it be?
- It is important to rule out conditions that can present with features similar to those of polymyalgia rheumatica, particularly conditions where use of systemic corticosteroids could have harmful consequences.
- The process of ruling out other possible conditions is lengthy, because diseases such as rheumatoid arthritis can take many months to become apparent, especially if treatment with corticosteroids is started. The initial diagnosis of polymyalgia rheumatica is thus, in effect, a 'working diagnosis'.
- Features that indicate increased likelihood of the diagnosis being a condition other than polymyalgia rheumatica include:
- Onset at less than 65 years of age.
- Incomplete response to treatment with corticosteroids.
- Weakness — suggests polymyositis.
- Prominent peripheral joint symptoms — suggest rheumatoid arthritis or remitting seronegative symmetrical synovitis with pitting oedema syndrome.
- Presence of other atypical clinical features (for example lack of shoulder pain, no muscle stiffness, and unilateral rather than bilateral girdle pain).
- See Table 1 for examples of disorders that can cause similar symptoms.
Table 1. Examples of disorders that can cause similar symptoms to polymyalgia rheumatica.
Differential diagnosis | Examples |
|---|
Degenerative disorders (may coexist with polymyalgia rheumatica and increase the need for steroid therapy) | Cervical and lumbar spondylosis Osteoarthritis Bilateral adhesive capsulitis (frozen shoulder), rotator cuff disorders Osteoporosis |
Endocrine disorders | Thyroid disease Parathyroid disease |
Infection | Chronic osteomyelitis Viral illness Tuberculosis Infective endocarditis |
Inflammatory disorders | Rheumatoid arthritis, often seronegative for rheumatoid factor (common) Spondyloarthropathy (rare) Remitting seronegative symmetric synovitis with pitting oedema (rare) Polymyositis/dermatomyositis Systemic lupus erythematosus Other connective tissue disorders |
Muscle disorders | Proximal myopathy (for example, corticosteroid-induced) Muscular dystrophy |
Malignancy | Multiple myeloma Leukaemia Lymphoma Lung carcinoma Other occult carcinomas |
Neurological disorders | Parkinson's disease Myasthenic syndromes |
Psychiatric disorders | Depression |
Drug adverse effects | Myositis or myalgia due to statins Polymylagia rheumatica-like syndrome due to quinidine |
Miscellaneous | Osteomalacia Fibromyalgia Chronic fatigue syndrome Chronic pain syndromes |
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