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Polymyalgia Rheumatica vs Rheumatoid Arthritis in the Elderly

Miguel A. Gonzalez-Gay, MD, PhD; Carlos García-Porrúa, MD
Arch Intern Med. 1997;157(17):2016. doi:10.1001/archinte.1997.00440380126014.
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Much has been written about polymyalgia rheumatica (PMR). However, its clinical differentiation from other secondary causes of polymyalgia remains unclear. In this respect, a subset of rheumatoid arthritis in the elderly presenting with acute polymyalgic symptoms shares many characteristics of classic PMR.2 In both entities, the shoulders and hip are commonly involved, the results of testing for rheumatoid factor are usually negative, severe morning stiffness is present, and the erythrocyte sedimentation rate is generally elevated.2,3 Also, distal edema and dramatic response to low doses of prednisone are frequently observed in both diseases.4,5 However, in our opinion, there are several clues that help to differentiate clinically both diseases. In polymyalgic onset of rheumatoid arthritis in the elderly, selective pain on pressure at the glenohumeral joint (over the glenohumeral fossa) is frequently found. Also, tenderness and swelling may occur in the wrists2. By contrast, as previously reported, arthritis in


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