fibromyalgia vs polymyositis vs polymyalgia rheumatica
- Keywords:: Step 3, Allergy and Immunology
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| Ddx | ||
|---|---|---|
| Clinical features | Diagnosis | |
| Fibromyalgia | Young to middle-aged womenChronic widespread pain Fatigue, impaired concentration Tenderness at trigger points (eg, mid trapezius, costochondral junction) | >3 months of symptoms with widespread pain index or symptom severity score Normal laboratory studies |
| Polymyositis | Proximal muscle weakness (eg, increasing difficulty climbing up stairs) Pain mild/absent | Elevated muscle enzymes (eg, creatine kinase, aldolase, AST) Autoantibodies (ANA, anti-Jo-1) Biopsy: Endomysial infiltrate, patchy necrosis |
| Polymyalgia rheumatica | Age >50 Systemic signs & symptoms Stiffness > pain in shoulders, hip girdle, neck Association with giant cell (temporal) arteritis | Elevated ESR, C-reactive protein Rapid improvement with glucocorticoids |
- polymyositis and dermatomyositis|Polymyositis: Involvement of upper esophageal musculature can cause dysphagia with regurgitation and aspiration. Initial remission can be induced with glucocorticoids (eg, prednisone), and most patients also receive a glucocorticoid-sparing agent (eg, methotrexate, azathioprine) to minimize the long-term adverse effects of treatment.