Case of polymyalgia rheumatica
This article describes the case of an 88-year-old woman with dementia who presented with the complaint of difficulty communicating. The patient had presented to the clinic 4 months earlier with complaints of fever and right knee joint pain. Doctors referred the patient for a right knee arthrocentesis which was significant for calcium pyrophosphate crystals. Based on these findings, doctors diagnosed the patient with monoarthritis pseudogout of the right knee joint. The case study further states that since then the patient has experienced multiple episodes of right knee monoarthritis which were relieved by non-steroidal anti-inflammatory drugs. The patient was diagnosed with polymyalgia rheumatica.
Her medical history further revealed that she developed a fever and difficulty moving because of generalised pain, 12 days before her visit to the hospital. A home doctor examined her and prescribed her NSAIDs. Doctors suspected that the patient had pseudogout in multiple joints. Similarly, her symptoms of fever and general pain did not show any improvement. The family member accompanying her further stated that the patient was unable to turn over on the bed because of generalised pain and developed bed sores. The family interview also revealed that the patient had a 2-week history of morning stiffness and persistent pain. However, doctors concluded that it may have been caused because of a new pressure ulcer.
Physical examination
The patient’s physical examination showed the patient’s level was E4V4M6 on the Glasgow Coma Scale. Her body temperature was 38.3°C, pulse rate 83/min, respiratory rate 16/min, blood pressure 146/70 and oxygen saturation 98% on ambient room air. The 88-year-old also complained of pain in both her shoulder joints. Similarly, her bilateral shoulder abduction was restricted to less than 90 degrees. On presentation, her right knee was swollen, painful and warm. A pressure ulcer was found in the sacral region. Doctors further advised blood tests which showed below-normal levels of albumin and increased levels of C-reactive protein and erythrocyte sedimentation rate. However, liver and kidney functions were normal.
The patient was referred for a plain radiograph of the right knee joint which showed changes of osteoarthritis. Joint ultrasound showed “hyperechoic areas suggestive of pyrophosphate crystals in the right knee joint” and “adhesive inflammation in the left long head of the biceps in the shoulder”. Based on these findings, the patient was diagnosed with polymyalgia rheumatica. She was treated with prednisolone and her symptoms showed significant improvement within 1 week. There were no signs of relapse at her 5-month follow-up.
