List systemic symptoms of polymyalgia rheumatica.
Constitutional symptoms: fever, weight loss, night sweats
Fatigue and malaise
Depressed mood
Symptoms of anemia
List musculoskeletal symptoms.
Musculoskeletal symptoms: primarily affects shoulders, neck, and pelvic girdle
New onset, symmetric pain that is worse at night
Morning stiffness (> 45 min)
Muscular atrophy and weakness: not directly caused by PMR but resulting from reduced activity due to pain and stiffness
Muscular pain and stiffness → limitation of activity → muscular wasting → muscular weakness
List other symptoms.
symptoms of giant cell arteritis (if both diseases are present)
List diagnostic tests.
↑ ESR, specifically > 50 mm/h
↑ CRP
Leukocytosis
Normochromic anemia
Normal creatine kinase, negative rheumatoid factors, and no autoantibodies
Bursitis on ultrasound of affected joints
DDs.
Giant cell arteritis
Both diseases often coexist and share common findings (e.g., elevated ESR, B symptoms)
May develop during the course of PMR (patients should be routinely evaluated for symptoms of GCA)
Rheumatoid arthritis: positive rheumatoid factor and/or anti-CCP antibodies
Polymyositis and dermatomyositis: ↑ serum creatine kinase (normal in PMR)
Fibromyalgia: normal laboratory values
Treatment
Low-dose oral glucocorticoids (alternatively IM glucocorticoids) [8]
Usually rapid symptomatic relief (2–4 weeks)
If symptoms improve: slowly taper and eventually stop glucocorticoids
No improvement after 2 weeks or relapse: increase dose
Etio
Unknown
Possible contributing factors are:
Genetic predisposition (e.g., human leukocyte antigen HLA-DR4)
Association with giant cell arteritis (GCA): Approx. 10% of individuals with polymyalgia rheumatica also have GCA. [4]
Epi
Sex: ♀ > ♂ (3:1) [1]
Most common inflammatory rheumatic disease in the elderly (second most common overall)
Age of onset: >70 years (rarely seen in patients < 50 years) [2]
More common in individuals of Northern European descent [3]
What are clinical features of poliomyelitis without CNS involvement?
Nonspecific symptoms: gastroenteritis, fever, nausea, sore throat, myalgia, and headaches for 1–3 days
Complete recovery without complications or transition to poliomyelitis with CNS involvement
Describe clinical features of poliomyelitis with CNS involvement (nonparalytic form) .
Nonparalytic poliomyelitis: aseptic meningitic form
Begins several days following abortive poliomyelitis (often temporary, symptom-free interval)
Fever, neck stiffness, headache, vomiting, muscle pain
Neck muscle weakness (head drop sign: head falls back when placed in a supine position)
No paresis
Describe clinical features of poliomyelitis with CNS involvement paralytic form) .
Paralytic poliomyelitis
Occurs 2–3 days following the meningitic form after a brief symptom-free interval
Fever, malaise, headache, nausea
Severe back, neck, and muscle pain
Asymmetric flaccid paralysis worsens over hours to days
Most commonly affects the leg muscles, although the arms, abdomen, trunk, thorax, and eyes may be affected
Paralysis is usually more severe in proximal muscles than in distal muscles.
Ascending paralysis with diaphragmatic involvement → respiratory failure
Bulbar form with brain stem involvement (rare): damage to the cerebral or autonomic nerve centers (cranial nerves and respiratory center) → central respiratory paralysis
Diminished deep tendon reflexes
Muscle atrophy
Hypotonia
Fasciculations
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