Chapter

Differential diagnosis

Dario Camellino and Marco A. Cimmino

in Polymyalgia Rheumatica and Giant Cell Arteritis

Published on behalf of Oxford University Press

Published in print April 2016 | ISBN: 9780198729204
Published online May 2016 | e-ISBN: 9780191795909 | DOI: http://dx.doi.org/10.1093/med/9780198729204.003.0009

Series: Oxford Rheumatology Library

Differential diagnosis

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The diagnosis of polymyalgia rheumatica (PMR), a common inflammatory disease characterized by pain and stiffness in the shoulder and hip girdles of elderly people, is based on clinical findings and laboratory markers of inflammation. Giant cell arteritis (GCA), the most frequent type of systemic vasculitis, is diagnosed on clinical findings, temporal artery biopsy, vascular imaging, and raised inflammatory markers. PMR and GCA overlap in about 50% of patients and a gold standard for their diagnosis is still lacking. Hence the diagnosis can be uncertain when the presentation consists only of non-specific symptoms, such as arthralgia, fever, and weight loss. Many late-onset inflammatory rheumatological diseases have a polymyalgic onset. As a result, it is important to differentiate PMR from other mimicking diseases, which include a wide range of conditions from elderly-onset rheumatoid arthritis to cancer. Pragmatically this is sometimes achieved only after a long follow-up.

Chapter.  2372 words.  Illustrated.

Subjects: Rheumatology ; Pain Medicine

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