Polymyalgia rheumatica kao diferencijalno dijagnostički problem - prikaz slučaja

Abstract

Introduction. Polymyalgia rheumatica (PMR) is a clinical syndrome connected to gigantocellular artheritis, mostly exhibited in elder patients. The most significant symptoms are pain and subjective stiffness in muscles of neck, shoulder and pelvis region, increased temperature, fatigue, loss of weight, and in laboratory tests there are increased sedimentation rate, higher values of other inflammation reactants and absence RF and ANA. From clinical aspect, differential diagnosis against malignant and infectious diseases is highly important. Case description. In female patient, age 70, pain and stiffness in neck, larynx and in pelvic region were present, with distinct fatigue and loss of body weight and sub-febrile temperature. After unsuccessful treatment with NSAID, she was referred to the neurologist and received a symptomatic therapy with little effect; subsequently extensive diagnostics was done - RTG of C and LS spine, CT of cervical and MR of LS spine, EMNG, which all took more than 6 months. Patient was treated by diagnosis of cervicobrachialgia and lumboischialgia, intermittently received depocorticoids that caused her to feel better for a time. Since symptoms were increased by time, she was referred to further laboratory tests, and due to increased sedimentation of over 100 was sent to the rheumatologist. On the basis of valid ACR/ EULAR criteria, PMR diagnosis was established and glicocorticoid therapy began immediately, which promptly caused subjective improvement and normalization of laboratory results. Conclusion. Since global population is ageing, our country included, it is important to have in mind the possibility of this disease. It is essential to establish diagnosis in time, in order to introduce adequate therapy, therefore avoiding unnecessary and expensive diagnostic procedures.