Mildly interesting question but worth taking the time to explore the differentials in this vignette.
Fibromyalgia. Prevalent in young - middle-aged & โ > โ. Chronic widespread pain with tender points. Symptoms of pain & stiffness prevalent but Pain > Stiffness. Associated with IBS, urge incontinence & palpitations. Labs tend to be normal. NSAID won't provide relief. This fits!
Polymyalgia Rheumatica. Just like Fibromyalgia, there are symptoms of both pain and stiffness. However, in polymyalgia rheumatica, Stiffness > Pain. The patients tend to be older (>50yr.) and systemic symptoms (fever, weight loss, night sweats, fatigue) tend to be more prevalent. Not seen in this vignette.
Polymyositis. In this diagnosis, proximal muscle weakness is often the chief complaint +/-- mild pain. Serology would show (+) antinuclear antibodies (ANA). The patient does not complain of weakness in this vignette.
Ankylosing Spondylitis. This is seen in โ > โ (3:1) so it becomes less likely. While pain/stiffness is seen in the back, neck, shoulders of these patients, tenderness is primarily seen at the sacroiliac joints. Furthermore, activity tends to improve symptoms (of stiffness) & NSAIDS would provide some relief. We don't see that in this case.
Seronegative RA. In this vignette, Labs show (--)ANA & RF but patients with this disease would present with joint pain & stiffness particularly in the hands, elbows, knees, feet and ankles. NSAIDS would also provide some relief.
Fibromyalgia classically leads to chronic widespread pain + tenderness at trigger points (pathognomonic) + normal labs and is often seen in anxious young patients (which is suggested by this patientโs diagnosis of irritable bowel syndrome)
Polymyositis: Proximal muscle weakness + elevated muscle enzymes + other signs of inflammation (ESR, CRP, etc.)
Polymyalgia rheumatica: Older patients with stiffness > pain and elevated markers of inflammation (ESR, CRP); important association with giant cell arteritis
submitted by โszsnikaa(28)
Mildly interesting question but worth taking the time to explore the differentials in this vignette.
Fibromyalgia. Prevalent in young - middle-aged & โ > โ. Chronic widespread pain with tender points. Symptoms of pain & stiffness prevalent but Pain > Stiffness. Associated with IBS, urge incontinence & palpitations. Labs tend to be normal. NSAID won't provide relief. This fits!
Polymyalgia Rheumatica. Just like Fibromyalgia, there are symptoms of both pain and stiffness. However, in polymyalgia rheumatica, Stiffness > Pain. The patients tend to be older (>50yr.) and systemic symptoms (fever, weight loss, night sweats, fatigue) tend to be more prevalent. Not seen in this vignette.
Polymyositis. In this diagnosis, proximal muscle weakness is often the chief complaint +/-- mild pain. Serology would show (+) antinuclear antibodies (ANA). The patient does not complain of weakness in this vignette.
Ankylosing Spondylitis. This is seen in โ > โ (3:1) so it becomes less likely. While pain/stiffness is seen in the back, neck, shoulders of these patients, tenderness is primarily seen at the sacroiliac joints. Furthermore, activity tends to improve symptoms (of stiffness) & NSAIDS would provide some relief. We don't see that in this case.
Seronegative RA. In this vignette, Labs show (--)ANA & RF but patients with this disease would present with joint pain & stiffness particularly in the hands, elbows, knees, feet and ankles. NSAIDS would also provide some relief.