Fibromyalgia and polymyalgia rheumatica are distinctly different, but in a case report described in the May 8 issue of the American Journal of Case Reports, Fawad Aslam, M.D., of Mayo Clinic in Arizona, and colleagues describe a confusing case of a 30-year-old woman.
In this article we summarize the case report, but also highlight the features that distinguish fibromyalgia and polymyalgia rheumatica.
This was a 30-year-old African-American woman with a year-long history of dysphagia, generalized muscle tenderness, tender neck lymphadenopathy, plus hypertension, asthma, gastroesophageal reflux disease, migraines, obesity (BMI of 41), and obstructive sleep apnea.
Her inflammatory markers were high. ESR was 100 mm/h as compared to a normall of less than 29. And, CRP was 35 mg/L as compared to a normal of less than eight.
Her symptoms included sudden onset of dysphagia, generalized muscle tenderness, and tender neck lymphadenopathy. She was initially diagnosed with polymyalgia rheumatica and was prescribed prednisone as long-term therapy at 20 mg daily.The treatment successfully resolved her symptoms, but they returned when the treatment stopped. Prednisone was resumed with methotrexate, but her mylagia symptoms worsened due to severe chronic steriod use.
At times, the pain and fatigue was so severe, she could not get out of bed, the authors reported.
Although initially diagnosed with polymyalgia rheumatica, doctors ultimately concluded she had fibromyalgia.
"Fibromyalgia is usually a diagnosis of exclusion in patients who present with chronic myalgias. Rendering a diagnosis of fibromyalgia requires a careful clinical
evaluation for any underlying condition that may be responsible for the fibromyalgia," the authors wrote.
Source: Rabia Cheema, April Chang-Miller, Fawad Aslam. "Myalgia with Elevated Inflammatory Markers in an Obese Young Female: Fibromyalgia or Polymyalgia Rheumatica?" American Journal of Case Reports. 2019; 20:659-663. DOI: 10.12659/AJCR.915564