A 72-year-old woman presents to her primary care physician with a 3-month history of aching and stiffness in her shoulders and hips bilaterally. She reports that the stiffness is particularly pronounced in the morning and lasts for several hours. She also reports feeling week in the hips and has difficulty standing from a seated position. Past medical history is significant for hypertension, hyperlipidemia, and major depressive disorder. She takes losartan, rosuvastatin, and escitalopram. Vital signs are within normal limits. On physical examination, there is restricted range of motion in the shoulders, but no muscle tenderness or weakness. Examination of the joints does not reveal any swelling, warmth, or erythema. No rashes are present. Laboratory tests reveal a normal complete blood count (CBC), an elevated erythrocyte sedimentation rate (ESR), and an elevated C-reactive protein (CRP).
C) Polymyalgia rheumatica
Polymyalgia rheumatica is an inflammatory rheumatic condition that causes aching and stiffness in the shoulders, neck, and hip girdle. It most commonly affects adults over 50 years of age, with a prevalence that increases with age and a peak incidence between 70 and 80 years. The stiffness is typically worse in the morning and can last for several hours. On physical examination, restricted shoulder motion is common, but muscle strength is usually preserved. The characteristic laboratory finding is an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), indicating inflammation.
Answer choice A: Fibromyalgia, is incorrect. Fibromyalgia is characterized by widespread musculoskeletal pain and tenderness, but it does not typically cause elevated inflammatory markers like ESR and CRP.
Answer choice B: Osteoarthritis, is incorrect. Osteoarthritis typically presents with joint pain and stiffness, but it is not associated with elevated inflammatory markers and usually affects the hands, knees, and hips.
Answer choice D: Rheumatoid arthritis, is incorrect. Rheumatoid arthritis can cause joint stiffness and elevated inflammatory markers, but it typically presents with joint swelling and tenderness, particularly in the small joints of the hands and feet.
Answer choice E: Systemic lupus erythematosus, is incorrect. Systemic lupus erythematosus can cause joint pain and elevated inflammatory markers, but it is usually associated with a wide range of systemic symptoms and specific autoantibodies such as anti-double-stranded DNA antiboides and anti-Sm antibodies.
Key Learning Point
Polymyalgia rheumatica is characterized by bilateral aching and stiffness in the shoulders, neck, and hip girdle, primarily affecting adults over 50 years of age. It is associated with elevated ESR and CRP.
