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Reminder of important clinical lesson
CASE REPORT
Pitfalls in diagnosing geriatric general pain: coexistence of polymyalgia rheumatism and fibromyalgia
  1. Yu Yokota1 and
  2. Hirofumi Namiki2
  1. 1 Japan Association for Development of Community Medicine, Tokyo Kita Medical Center, Tokyo, Japan
  2. 2 Japan Association for Development of Community Medicine, Tokachi-Ikeda Community Center, Hokkaido, Japan
  1. Correspondence to Dr Yu Yokota, u.may.52.lv{at}gmail.com

Abstract

Polymyalgia rheumatism and fibromyalgia are clinically similar. As there are no specific diagnostic markers, they are difficult to distinguish. A 92-year-old woman with a 3-month history of general pain, including left hip pain, was referred to our hospital. Her medical history included polymyalgia rheumatism that had been treated with prednisolone for 18 years. We found 14 of 18 symmetrical tender points. We diagnosed fibromyalgia based on two physical examinations and her personal history of general pain. Pregabalin was prescribed, and her pain gradually disappeared. About a month later, she complained of returned buttock pain and fever. She was diagnosed with exacerbation of polymyalgia rheumatism by various examinations and was treated with prednisolone. We found 3 of 18 asymmetrical tender points. No symptoms had recurred at the 1-month follow-up visit. Her case provides an opportunity to highlight the possible pitfalls when diagnosing geriatric general pain.

  • geriatric medicine
  • pain
  • fibromyalgia
  • musculoskeletal syndromes
  • orthopaedics

https://doi.org/10.1136/bcr-2019-230078

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    Footnotes

    • Contributors YY and HN contributes to conception and design, acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version published, and agreement to be accountable for the article and to ensure all questions regarding the accuracy or integrity of the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained