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5 Cards in this Set
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60 y/o female with acute onset of
pain and muscle stiffness in bilateral shoulder and hip joints, c/o inability to perform am routines upon awakening.Difficulty in chores, |
PMR is a Rheumatic disorder
that typically involves elderly (age>50) that is Inflammatory in nature targeting proximal muscles and joints resulting in acute pain and stiffness with some constitutional symptoms |
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Incidence of PMR-
age >50 y/o Woman > men ( 2:1) Scandinavians |
Etiology of PMR
Genetic predisposition -HLA DR-04 allele Infectious? Auto Immune? Not clear. |
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Hall Mark features of PMR-
B/L achiness, stiffness proximal girdle pain (hip, Shoulder) Responds better to low dose steroids |
Clinical manifestations of PMR-
Elderly -age usually in 60's Depression wt loss B/L tenderness in arm muscles (early) stiffness Neck,shoulder&pelvic girdle " feels like its a flu that won't go away" Pain in both Night time and AM AM is the worse pain patient usually moans and is restless. Manual strength test is usually normal |
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Systemic involvement-
fatigue fever wt loss Sweats Symptoms Of Temporal Arteritis HA, Loss of vision jaw claudication/TMJ Low level synovitis (shoulder,hips) Bursitis Unusual presentations- sternoclavicular synovitis CTS Distal swelling,edema asymmetric pain. |
LABS-
No confirmatory tests. Dx is by Clinical Hx ,progression Routine labs- CBC- anemia ESR- >40 CPK- rise CK LFT alk Phosphatase,GGT IL 6 levels-rise |
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DDx for PMR-
Statin -Myopathy Hypothyroid myopathy RCT/bursitis Bacterial endocarditis RA Myelopathies Myositis Fibromyalgia Depression periarthritis of shoulder |
pain of PMR is probably due to proximal synovitis.
Experimental Investigative studies- Joint taps- low level synovitis Bone scans- Increased vascularity in proximal jts MRI- mild bursitis,synovitis |
