Polymyalgia rheumatica

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Polymyalgia rheumatica



Polymyalgia rheumatica


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Polymyalgia rheumatica

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USMLE® Step 1 style questions USMLE

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A 67-year-old woman comes to the outpatient provider for evaluation of fatigue and muscular pain for the past 4 months. The patient also reports muscle stiffness that is worse when waking up in the morning and improves after several hours. Family history is notable for rheumatoid arthritis in the patient’s mother. Past medical history is notable for hypertension and hyperlipidemia. Temperature is 38.1°C (100.6°F), blood pressure is 145/90 mmHg, pulse is 68/min, and respiratory rate is 12/min. There is tenderness to palpation in the muscles of the bilateral shoulders and hips. No muscle weakness is noted. Laboratory testing reveals the following results:  
Laboratory value  Result
 Hemoglobin  14.7 g/dL 
 Leukocyte  7,900/mm3 
 Erythrocyte Sedimentation Rate (ESR)   105 mm/h 
 Serum creatinine kinase  76 U/L 

Which of the following symptoms is the patient at the greatest risk of developing?

External References

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for polymyalgia rheumatica p. 481

Polymyalgia rheumatica p. 481

associations p. 728

ESR in p. 212

giant cell arteritis and p. 482

Temporal arteritis

polymyalgia rheumatica p. 481

Weight loss

polymyalgia rheumatica p. 481


With polymyalgia rheumatica, “poly-“ means many, “mya-” means muscles, and “-algia” means pain.

“Rheumatica” comes from rheumatism, which broadly refers to conditions that affect the joints and connective tissue.

So, polymyalgia rheumatica is a disorder that causes muscle pain and joint stiffness.

It is considered to be an immune- mediated disease, meaning that the immune system attacks our own body.

It is important to note that although “myalgia” means muscle pain, the muscles are usually spared and it's the tissue around the joints that mostly gets inflamed.

Normally, the cells of the immune system are always hanging around, ready and excited to spot and fight against anything foreign that could cause harm inside the body.

One particular type of immune cell - the dendritic cell - is a type of antigen-presenting cell, meaning that it grabs a pathogen for example a bacteria, destroys it, and presents a part of that bacteria, called an antigen, to other immune cells.

Dendritic cells take their name from the fact that they have branch like arms called dendrites which help them grab antigen.

Dendritic cells take their captured antigen and move over to a nearby lymph node, where they present the antigen to a helper T-cell.

Dendritic cells “present” the antigen on a protein called a major histocompatibility complex, or MHC, class II molecule which is on their cell surface.

MHC class II molecules are like a serving platter, which hold the antigen as it gets presented to the helper T-cells.

Once these antigens are recognized as foreign, T-helper cells get activated and start secreting a lot of proinflammatory cytokines, or signalling molecules, that recruit more immune cells, such as macrophages, to the site of inflammation.


Polymyalgia rheumatica (PMR) is an autoimmune disorder that causes inflammation in the muscles and joints, resulting in joint pain and stiffness, usually in the shoulders and hips. Symptoms usually develop in people over the age of 50 and may include fatigue, muscle and joint pain, stiffness, loss of appetite, weight loss, and fever. Treatment of polymyalgia rheumatica focuses on suppressing the immune response, usually with low doses of corticosteroids, such as prednisone. Specific exercises and a healthy diet can also help strengthen the muscles and bones, as well as improve flexibility of the affected joints.


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  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Cytokines in Polymyalgia Rheumatica and Giant Cell Arteritis" Polymyalgia Rheumatica and Giant Cell Arteritis (2010)
  6. "Clinical presentation and classification criteria for polymyalgia rheumatica" Polymyalgia Rheumatica and Giant Cell Arteritis (2016)

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