Abstract | November 6, 2020

Eye Am Weak: A Case of Polymyalgia Rheumatica (PMR)

Presenting Author: Justin Chin, D.O., Family Medicine Resident - PGY3, Family Medicine Residency Clinic, Eglin AFB, FL

Co-Author: Mary Temipote Ileso, Doctor of Osteopathic Medicine, Family Medicine Resident PGY2, Family Medicine Residency Clinic, Eglin Air Forice Base, Eglin, Florida

Learning Objectives

  1. Diagnose and treat PMR based on key clinical features and laboratory findings.
  2. Recognize link between PMR and Giant Cell Arthritis, and perhaps other autoimmune conditions.
  3. Anticipate effect of treatment on patient’s existing conditions and adjust as necessary..

Introduction: Polymyalgia Rheumatica is the most common chronic inflammatory condition in older adults, with an incidence of 100 per 100,000 in patients over 50 years old. It is associated with Giant cell arteritis, which is the most common type of vasculitis in adults that can result in blindness.

Case Presentation: A 73 year-old-male with PMH significant for Type II Diabetes, hypertension, and history of anterior uveitis with HLA-B27 antigen (recent flare 2 weeks ago) presents to ED for chills, weakness, difficulty getting up from couch, bilateral wrist and leg pain, 8-days of joint pain/stiffness especially after lying down. Vital signs were normal, and physical exam was remarkable for mild thyromegaly and 4/5 muscle strength in L2, L3. Initial differential diagnosis included PMR, myositis, and diabetic neuropathy. Labwork revealed CRP 17.5, ESR >130, platelets 438, CK 32, HgbA1c 8.3, TSH within normal limits.

Final/Working Diagnosis: Considering the patient’s abrupt onset of bilateral proximal muscle weakness of shoulder and pelvic girdle, and wrists, relatively preserved muscle strength, prolonged morning stiffness, lack of chronic pain syndromes, elevation of acute phase reactants, slight thrombocytosis and normal CK, PMR was the final diagnosis. He did not have temporal tenderness, jaw claudication or new-onset headache, so no workup for Giant Cell Arthritis was performed at this time.

Management and Follow-up: He was given Prednisone 80 mg in the ED with vast improvement of his symptoms the following day, and discharged home on Prednisone 20 mg daily with PCM follow up and rheumatology referral. His diabetic medications were adjusted in anticipation of higher blood glucose levels, and he was placed on a proton pump inhibitor for GI protection while on steroids. He was later found to be positive for dsDNA antibody, indicating that he had multiple autoimmune diseases to include spondyloarthropathy, PMR, and lupus.

Posted in: Rheumatology and Orthopedics4