Case Studies

 Case 10.13 Polymyalgia rheumatica

A 73-year-old woman presented with sudden pain and stiffness of her shoulder muscles. She had become increasingly depressed over the preceding 3 months, with anorexia and loss of weight. On examination, there was limitation of movement of both shoulders with muscle tenderness; neurological examination was normal. The temporal arteries were extremely tender on palpation. On investigation, her haemoglobin was 121g/l with a raised CRP of 68mg/l. A diagnosis of polymyalgia rheumatica and temporal arteritis was made and a temporal artery biopsy taken. Treatment was started immediately with 60mg of prednisolone daily and within 24h the patient was markedly improved; she became more alert and her muscle stiffness lessened. The temporal artery biopsy showed a vasculitis with infiltration by lymphocytes, macrophages and giant cells (Fig. 10.10b). Improvement continued over the next few days. Steroids were gradually withdrawn over 2 months but her polymyalgia relapsed a year later and she again improved on steroids.