Magnetic resonance imaging in the differential diagnosis between polymyalgia rheumatica and elderly onset rheumatoid arthritis

Excerpt

In March 2001, an 80-year-old man was attended to in a rheumatological outpatient clinic because of loss of appetite, nausea, malaise, and fatigue after prostectomy for adenoma. Shortly thereafter, he experienced pain in the cervical spine and shoulder girdle associated with morning stiffness and raised erythrocyte sedimentation rate. A diagnosis of polymyalgia rheumatica (PMR) was made, and the patient was treated with methylprednisolone, 8 mg/day. Symptoms subsided and inflammation indexes normalized. The dosage of steroid was progressively tapered until March 2003, when the attending physician discontinued treatment. After a few days, the patient experienced an exacerbation of pain in the shoulders, accompanied by pain and swelling of several metacarpophalangeal joints and of the knees. When the patient presented to our outpatient clinic, erythrocyte sedimentation rate was 87 mm/h, C-reactive protein was 85.3 mg/dL, and IgM rheumatoid factor was negative. …