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Clinical, radiological, and biochemical characteristics in patients with diseases mimicking polymyalgia rheumatica

Hidekatsu Yanai1, Hiroshi Yoshida, Norio Tada

  • 1Division of General Medicine, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa, Japan. yanaih@jikei.ac.jp

Clinical Interventions in Aging
|October 24, 2009
PubMed

Insights

Differentiating polymyalgia rheumatica (PMR) from similar conditions like pseudogout and RS3PE syndrome is crucial. Prompt C-reactive protein reduction with NSAIDs helps distinguish pseudogout and post-infectious polyarthritis from PMR.

Area of Science:

  • Rheumatology
  • Diagnostic Imaging
  • Clinical Chemistry

Background:

  • Polymyalgia rheumatica (PMR) shares clinical and laboratory features with several other conditions, complicating diagnosis.
  • Accurate differentiation is essential for appropriate treatment and patient management.

Observation:

  • Gallium-67 scintigraphy, serum C-reactive protein (CRP), matrix metalloproteinase-3 (MMP-3), and vascular endothelial growth factor (VEGF) were evaluated in patients with PMR and mimicking diseases.
  • Initial scintigraphic findings and serum marker levels were similar across PMR, pseudogout, RS3PE syndrome, and post-infectious polyarthritis before treatment.

Findings:

  • A significant reduction in serum CRP levels within one week of nonsteroidal anti-inflammatory drug (NSAID) administration effectively differentiates pseudogout and post-infectious polyarthritis from PMR.
  • Chondrocalcinosis on joint radiographs aids in distinguishing pseudogout from PMR.
  • Pitting edema of the hands and symmetric gallium uptake in metacarpophalangeal (MCP) joints are characteristic features that help identify RS3PE syndrome.

Implications:

  • Pseudogout, RS3PE syndrome, and post-infectious polyarthritis should be considered within the differential diagnosis of PMR.
  • The response of serum CRP levels to NSAIDs serves as a valuable diagnostic clue.
  • Specific clinical signs and imaging findings can reliably distinguish between these rheumatological conditions.
Keywords:
RS3PE syndromegallium-67 scintigraphypolymyalgia rheumaticapost-infectious polyarthritispseudogout

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