A 79-year-old white woman presented with ulcerative colitis of 12 years’ duration and osteoporosis as identified by dual-energy x-ray absorptiometry (DEXA) (T-scores, _2.3 in the lumbar spine and _2.9 in the total hip). Her ulcerative colitis had been well controlled with a regimen of azathioprine and mesalamine. Before starting this regimen, she had been receiving long-term corticosteroid therapy until about 3 years before presenting to our clinic.
The patient was referred to rheumatology for severe proximal muscle pain that was unresponsive to NSAID therapy. Results of her physical examination showed no synovitis, rash, or weakness.
The patient’s erythrocyte sedimentation rate was 85 mm/h (normal, 0 to 20 mm/h).A clinical diagnosis of polymyalgia rheumatica (PMR) was made.
The image at left is an x-ray of her spine taken as part of screening for an institutional corticosteroid-induced osteoporosis program.
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