Polymyalgia rheumatica: a diagnostic challenge in the elderly with haemophilia and diffuse arthropathy

With the increased life expectancy and associated comorbidities in haemophilic patients, greater awareness is needed to avoid being misled by symptoms mimicking haemophilia-related conditions. Here, we discuss the case of a 77-year-old man with congenital moderate haemophilia complicated by diffuse haemophilic arthropathy. He presented with persistent pain and stiffness affecting both shoulder and pelvic girdles, unresponsive to factor VIII (FVIII) infusions. A blood test confirmed the high clinical suspicion of polymyalgia rheumatica (PMR), justifying a course of low-dose methylprednisolone that led to significant clinical and biological improvement. This is the first reported case of congenital haemophilia and PMR. We here review some elements helpful to overcome this diagnostic challenge. Adequate diagnosis and management of PMR in elderly patients with haemophilia is particularly important not only to relieve pain but also to avoid inappropriate use of clotting factor concentrates.