Polymyalgia rheumatic (PMR) is an inflammatory disease whose main characteristic pain and stiffness in the waist, shoulders, hips and neck. Although it is related to other pathologies or present similar symptoms, it is important that both the patient and the rheumatologist know the differences.
Giant cell arteritis and Polymyalgia Rheumatic
Symptoms of giant cell arteritis (GCA), such as headache, sensitivity of the temporal artery, jaw pain, evidence of cerebral ischemia or loss of vision, not often occur in PMR. If so, it is important that the rheumatologist make continuous monitoring of these symptoms.
Polymyalgia Rheumatic arthritis and Reumatolide
Patients with arthritis Reumatolide (AR) tend to have symmetric polyarthritis in the small joints of the hands and feet, which is persistent and partially responds to low doses of prednisone, a corticosteroid drug. These symptoms are different from the PMR, in which there are not many inflamed joints and normally responds to low doses of prednisone.
RS3PE syndrome and Polymyalgia Rheumatic
RS3PE symptoms syndrome (seronegative symmetrical synovitis with pitting edema sender) can be easily confused with PMR. The main features of RS3PE syndrome that differentiate it from the PMR are:
- sudden onset of polyarthritis
- It affects more older than 50 years old
- Lack rheumatoid factor (abnormal on the globulin serum)
- Symptoms are usually more prominent distally
- Some patients respond to treatment with low doses of glucocorticoids
- It may be considered a variant of edema PMR
Spondyloarthropathy and Polymyalgia Rheumatic
In the espondilartropatía (SpA) late onset constitutional symptoms may appear, such as fever, weight loss and anorexia, along with an elevated erythrocyte sedimentation rate (rate at which red blood cells "fall"). But other symptoms that are not normally in the PMR, such as inflammation of muscles, ligaments, fingers and toes, the sacroiliac joints (where the lumbar spine connects with the pelvis), and a higher prevalence also appear HLA-B27 positive.
Hypothyroidism and Polymyalgia Rheumatic
Patients with hypothyroidism may experience pain and stiffness in the joints, but the differential factor is the alteration of thyroid hormones, which would give the diagnosis.
Rheumatic Fibromyalgia and Polymyalgia
Although it may present clinically similarly, patients with fibromyalgia have an erythrocyte sedimentation rate, hematocrit and normal protein C, unlike the PMR.
Tendinitis, Bursitis and Polymyalgia Rheumatic
Symptoms shoulders with PMR may be similar to those of the subdeltoid bursitis (under the deltoid, shoulder muscle that is responsible for raising the arm) or tendinitis of the rotator cuff (muscles that give stability to the shoulder). However, unlike PMR, patients with tendinitis or bursitis have no constitutional symptoms, ie, weight loss, fatigue and anorexia. Nor have an elevated erythrocyte sedimentation rate and anemia.
Malignancies and Polymyalgia Rheumatic
There is no relationship between the appearance of the PMR and malignant tumors. However, some cancer patients may have pain in the muscles and similar to those of the PMR joints, but in this case do not respond to prednisone.
And Polymyalgia Rheumatic Infective Endocarditis
This and other infectious diseases can be confused with PMR, but symptoms that differentiate endocarditis PMR are heart murmurs, persistent fever, adenoids in a heart valve (formation of clumps of tissue within the heart) and positive blood cultures .
Polymyalgia Rheumatic inflammatory myopathy
Muscle diseases such as polymyositis or dermatomyositis usually present with symmetrical proximal muscle weakness, but the pain is not as intense as in PMR. Other distinguishing factors are abnormal electromyography, elevated levels of muscle enzymes or evidence of myositis on muscle biopsy.