Ddx: Polymyalgia Rheumatica and Polymyositis - negenand

[ArchivalUser]

What are the main points help you to differentiate between Polymyalgia Rheumatica and Polymyositis?

[ArchivalUser]

Polymyalgia is pain and stiffness in the musles with many different trigger points. Worse aftre rest. Usu ESR is high. Muscle strength preserved. Rule out hypothyroidism and Rx with steroids.
Polymyositis is characterized by fatique and weakness in proximal muscles and may invove the esophagus with dysphagia. Pt cannot go up and down the stairs , squat, sometimes arthralgia and Reynaud's. Anti Jo-1, EMG for diagnosis.The definitive diagnosis is by muscle biopsy. Also Rx with steroids.

[ArchivalUser]

its fibromyalgia not poymyalgia which is associate with tenderness at more than 11 pts whereas polymyagia rheumatica is as with morning stiffness for atleast 30 min and occurs in elderly.

[ArchivalUser]

dont get confuse - Polymyalgia rheumatica - stiffnes, rather then pain, shoulder,pelvic girdle.
- remember 50, 40,30 - age 50 and more
40 ESR
30 days symptoms

Associate trigger points with FIBROMYALGIA- all labs are normal, often fatigue + poor sleep.

Polymyositis - agree with amygdala, first test would be CK,aldolasa - elevated
biopsy - confirmation.
Dermatomyositis - polymyositis + skin manifestation - Heliotropic rasth, Gotron.
Both conditions can have underlying malignancy - search for it.

TX:
Polymyalgia rheumatica - low dose cortico
Fibromyalgia - TCA -not autoimmune , before try exercise program, after consolidation start TCA
Dermato/polymyositis - cortico

NOTE: important underlying association - Polymalgia rheumatica and Giand cell arteritis - 50% pts with polymyalg rheuma will have giant cell arteritis

When and how to look for giant cell arteritis?

If the patient has some clinical signs . headache - retroorbital, jaw pain ,

DX - do temp. art. biopsy -
TX -HIGH DOSE CORTICO. must be done - prevent main complication BLINDNESS.
you can start with cortico even before biopsy, it wont change the result of bioptic histopatho.

[ArchivalUser]

wonderful dr tibor.

[ArchivalUser]

Sorry guys, scratch the trigger points. Thank you for correcting.

[ArchivalUser]

OH/

EXCELLANT AND COMPLETE TIBOR/ YOU DESRVE A

5/5

I LOVE THAT 30 DAYS SX 40 ESR AND AGE 50 FOR RHEMATICA

THATS WONDERFUL THAT INFLAMMATION AUTOIMMUNE / VASCULITIS/ FUNCTIONAL AND PSYCHOGENIC ABD PARANEOPLASTIC SYNDROME ALL COME IN ONE PLACE

[ArchivalUser]

Sx
pain=fibromyalgia
weakness=polymyositis
stiffness=polymyalgia rheumatica

[ArchivalUser]

Great! Thanks for all of your discussions. Thanks for Tibor making the differentiation complete.

[ArchivalUser]

i like it
30 days/40esr /50 yrs of age

pain= fibromyelgia

weakness = polymyositis

stiffnes= polumyelgia rheumatica

fibromyelgia -tca

polymyelgia - low dose steroid

polymyositis/dermato--steroid