Article Text

SP0168 Case 1 Presentation: An Elder Patient with Intensive Pain in Both Arms
  1. A. Sulli
  1. Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy


Polymyalgia rheumatica (PMR) is an acute musculoskeletal inflammatory disease of ageing people, characterized by clinical symptoms that may create some difficulties in the differential diagnosis with elderly onset RA (EORA) [1]. Furthermore, 20% of PMR patients develop overt RA during the follow-up, and EORA may present with a PMR-like onset [2].

Common symptoms of PMR may be aching and stiffness in the shoulder and in the pelvic girdles, less frequently arthritis of hands and wrists (23% of cases) [3]. The occurrence of peripheral arthritis may create some difficulties in the differential diagnosis between PMR and EORA, even if rheumatoid factor or anti-citrullinated peptide positivity, symmetrical involvement of wrist, metacarpophalangeal and interphalangeal joints, development of joint erosions and extra-articular manifestations help to differentiate EORA from PMR [3,4]. Treatment response may also help, as PMR usually responds rapidly and better to glucocorticoids than EORA, and has a favourable prognosis [5].

Imaging plays an important role in the comprehensive evaluation of PMR, including its diagnosis and follow-up, allowing appreciation of bursitis, synovitis, soft tissue inflammation and vasculitis [6]. Moreover, imaging patterns of PMR inflammation could help in the diagnostic process and in differential diagnosis with other disease like EORA [3,6].

Different, cytokine, hormonal, inflammatory milieux have been also described in these two clinical conditions [4,5,7,8], and classification criteria have been recently provided for PMR [9].

The clinical case of a seventy-one year old male patient, admitting with pain, stiffness and articular limitation in shoulder and pelvic girdles along with increased inflammatory indexes, will be presented and discussed. Partial response to corticosteroids and progressive improvement until remission after methotrexate administration contributed to confirm the final diagnosis.


  1. Pease CT, Haugeberg G, Morgan AW, et al. J Rheumatol 2005; 32:1852–7.

  2. Caporali R, Montecucco C, Epis O, et al. Ann Rheum Dis 2001; 60:1021–4.

  3. Pease C, Haugeberg G, Montague B et al. Rheumatology 2009; 48:123–7.

  4. Cutolo M, Cimmino MA, Sulli A. Rheumatology (Oxford). 2009; 48:93-5.

  5. Sulli A, Montecucco CM, Caporali R et al. Ann N Y Acad Sci 2006;1069:307–14.

  6. Camellino D, Cimmino MA. Rheumatology (Oxford) 2012; 51:77-86.

  7. Cutolo M, Montecucco CM, Cavagna L, et al. Ann Rheum Dis 2006; 65:1438–43.

  8. Cutolo M, Sulli A, Pizzorni C, et al. Ann NY Acad Sci 2002; 966:91-6.

  9. Dasgupta B, Cimmino MA, Maradit-Kremers H, et al. Ann Rheum Dis 2012; 71:484-92.

Disclosure of Interest None declared

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.