Abstract

To the Editor:

A patient that I recently saw illustrates how polymyalgia rheumatica (PMR) may not be immediately obvious in patients with dementia. In May 2008, an elderly woman with Alzheimer disease was hospitalized under my care after falling and being unable to get up. She initially denied any pain or discomfort, to myself and the admitting emergency room physician. Routine studies were unremarkable except for a urinary tract infection and a sedimentation rate of 61 mm/hr. She could not or would not get out of her hospital bed, and when I pressed hard on her biceps, triceps and quadriceps, she grimaced. Her distal muscles were not tender. Upon polite, but persistent, questioning, she said that “maybe” she had been hurting over the past months but really was not sure. Twelve hours after getting 20 mg of prednisone, she no longer had proximal muscle tenderness and could walk normally, which established a diagnosis of PMR. She was still significantly impaired cognitively, unlike the case of a 58-year-old who completely recovered mental faculties once corticosteroids were given,¹ but at least her mobility was restored.