A 75 yo F with history of DM2, HTN, and OA presents with progressive stiffness originating in her shoulders and neck with more recent involvement of the bilateral lateral hips for 5 weeks.
History
- Symptoms present in the morning and improve with activity.
- Acetaminophen provides minimal relief.
Physical Exam
- Normal VS
- Pain with palpation of shoulders and lateral hips, preserved strength
- No evidence of swelling in small joints of hands and feet
- 5/5 strength in upper and lower extremities
Diagnostic Workup
- Labs: CRP 31 mg/L (H), ESR 75 (H), CBC with mild normocytic anemia, CMP wnl
- Imaging: shoulder x-ray with mild degenerative changes bilaterally
Treatment
- Prednisone 20 mg per day resolved patient’s symptoms within 48 hours, but blood sugar uncontrolled
- Second line treatment: patient started on SQ sarilumab with ability to taper off of steroids and without recurrence of PMR symptoms