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Spondyloarthropathy presenting as a polymyalgia rheumatica-like syndrome
A Ponce1, R Sanmarti, C Orellana
1Department of Rheumatology, Hospital Clínic i Provincial de Barcelona, Spain.
Clinical Rheumatology
|February 10, 1998
Summary
Polymyalgia rheumatica (PMR) was initially suspected in two patients presenting with shoulder and pelvic girdle pain. However, a lack of steroid response led to a revised diagnosis of spondyloarthropathy (SpA), highlighting its varied presentation.
Area of Science:
- Rheumatology
- Clinical Medicine
Background:
- Polymyalgia rheumatica (PMR) is often characterized by shoulder and/or pelvic girdle pain and stiffness, typically accompanied by elevated erythrocyte sedimentation rate (ESR).
- Late-onset spondyloarthropathy (SpA) can present with a heterogeneous clinical spectrum, sometimes mimicking other rheumatic conditions.
Observation:
- Two female patients, aged 57 and 58, presented with symptoms suggestive of PMR, including girdle pain/stiffness and high ESR.
- These patients did not respond to low-dose corticosteroid therapy, prompting a re-evaluation of the initial diagnosis.
Findings:
- A thorough clinical evaluation and review of past medical history led to a revised diagnosis of spondyloarthropathy (SpA) in both patients.
- This case illustrates that late-onset SpA can manifest as a polymyalgia-like syndrome, challenging initial diagnostic assumptions.
Implications:
- The findings underscore the importance of considering SpA in the differential diagnosis of polymyalgia-like syndromes, especially when patients exhibit an atypical response to steroids.
- Recognizing this overlap can lead to earlier and more accurate diagnosis and management of SpA, potentially improving patient outcomes.