Early onset polymyalgia rheumatica: two rare cases under age of 50.
Polymyalgia rheumatica (PMR) is almost an exclusive disease of adults over the age of 50, and only a few cases have been reported. Two 46-year-old females visited our locomotor pain clinic with multiple joint pain with increased acute phase reactants. Rheumatologic markers, and HLA-B27 were checked. Serum protein electrophoresis and serum immunofixation electrophoresis, imaging studies including plane image, sonography, and magnetic resonance image was done.18F-Fludeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed characteristic findings of PMR, without evidences of sacroiliitis. Since PMR can develop in mid 40s, a high index of suspicion is necessary in younger patients presenting the bilateral pain in shoulders, hips, and back, with elevated acute phase reactants. Furthermore, in addition to the previous case reports, FDG-PET/CT is helpful in making early differential diagnosis of PMR in patients under the age of 50. Here we present two cases of PMR onset in the mid-40s emphasizing the importance of diagnostic imaging for early differential diagnosis in PMR.
Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea.
Jinyoung
J
Park
Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Irwon-Ro, Gangnam-gu, Seoul, Korea, 06351. yays.sung@samsung.com.
Duk Hyun
DH
Sung
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018771:Arthralgia / Q000000981:diagnostic imaging / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging; D008875:Middle Aged; D011111:Polymyalgia Rheumatica / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D000072078:Positron Emission Tomography Computed Tomography; D011239:Prednisolone / Q000627:therapeutic use; D019275:Radiopharmaceuticals; D051598:Whole Body Imaging / Q000379:methods
D000893:Anti-Inflammatory Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D011239:Prednisolone
18F-Fluorodeoxyglucose; Polymyalgia rheumatica; Positron-emission tomography; Rheumatoid arthritis; Spondylarthropathies