Differentiating Polymyalgia rheumatica from other diseases: Difference between revisions

Latest revision as of 21:23, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

Polymyalgia rheumatica (PMR) must be differentiated from other conditions such as late onset rheumatoid arthritis, polymyositis, dermatomyositis, fibromyalgia, and remitting seronegative symmetrical synovitis with pitting edema.

Differentiating Polymyalgia Rheumatica from other Diseases

Polymyalgia rheumatica (PMR) must be differentiated from other conditions such as late onset rheumatoid arthritis, polymyositis, dermatomyositis, fibromyalgia, and remitting seronegative symmetrical synovitis with pitting edema.^[1]^[2]^[3]^[4]

Differentiating polymyalgia rheumatica on the basis of fatigue and chronic pain

Disease	Differentiating signs and symptoms	Diagnostic findings
Polymyalgia rheumatica	Older at onset Generalized stiffness	Elevated ESR or CRP Response to corticosteroids
Fibromyalgia	Symptoms have been present at a similar level for at least 3 months. Chronic musculoskeletal pain with multiple tender points Stiffness, numbness, and fatigue Headaches Sleep disorder	All lab tests are normal
Rheumatoid arthritis	Multiple joint swelling Morning stiffness Rheumatoid nodules	Positive RF or anti-cyclic citrullinated protein (CCP) antibody Elevated ESR or CRP
SLE	Maculopapular rash Multi-system involvement	Positive anti-Smith antibodies
Chronic fatigue syndrome	Fatigue plus 4 of the following symptoms: Short-term memory loss Sore throat Tender lymph nodes in the neck or armpit Muscle pain Joint pain without swelling or redness Headaches Insomnia Malaise	Diagnosis of exclusions Symptoms must present for more than 6 months
Spondyloarthritis	Axial skeletal pain and stiffness Restricted spinal motion	Elevated ESR or CRP Negative RF Bamboo spine on x-ray
Osteoarthritis	Localized joint pain Restricted to affect joints Older at onset	Degenerative joint changes on x-ray
Hypothyroidism	Systemic symptoms such as weight gain, constipation, dry skin Muscular aching Prominent fatigue	Elevated TSH Low free T4
Polymyositis and dermatomyositis	Pelvic and shoulder girdle muscle weakness Rash	Muscle biopsy confirms the diagnosis Elevated CPK enzyme
Neuropathy	Numbness and tingling Paresthesia	Abnormal EMG

Differentiating polymyalgia rheumatica from other causes of inflammatory myopathy

Organ system	Disease	Symptoms												History	Physical Examination	Diagnosis
Organ system	Disease	Age of onset	Muscle weakness	Fever	Myalgia	Contractures	Gait abnormality	Neuropathy	Atrophy	Stiffness	Myoglobinuria	Other features	Laboratory Findings	History	Physical Examination	Creatine Kinase	Muscle Biopsy	Electromyogram
Inflammatory/ Rheumatologic	Polymyalgia Rheumatica^[5]	50s	Diffuse	+	+	−	−	−	−	+	−	Weight loss	History of joints stiffness, worse in the morning	Restricted shoulder motion	↑↑ ESR ↑↑ CRP	Normal	Normal	Normal
	Dermatomyositis^[6]	40s−50s Can affect children	Proximal	+	+	−	−	−	−	+	−	Rash Dyspnea Weight loss Cough	Viral infections Cancer	Heliotrope rash on face and hands Telangiectasia Erythema Mechanic's hands Gottron's sign ( violaceous scaly eruption )	↑↑ ESR ↑↑ CRP	↑↑	Perimysial mononuclear infiltrate	Myopathic
	Polymyositis^[7]	> 18 years	Proximal	+	+	−	−	−	−	+	−	Similar to dermatomyositis without mucous and skin involvement	N/A	N/A	↑↑ ESR ↑↑ CRP	↑↑	Endomysial mononuclear infiltrate Patchy necrosis	Myopathic
	Inclusion body myositis^[8]	50s	Proximal & distal	−	−	−	−	−	−	−	−	Dysphagia Asymmetric weakness	Retrovirus (most common)	N/A	Antibodies to cytoplasmic 5'−nucleotidase	↑↑	Inflammatory cells Invading muscle cells Vacuolar degeneration Inclusions or plaques	Neurogenic
	Fibromyalgia^[9]	40−50s	Generalized	−	−	−	−	+	−	−	−	Anxiety or depression features Fatigue Sleep disturbance Numbness Muscle spasms	History of depression	Tenderness in the soft tissue anatomical location	Normal	Normal	Normal	Normal
Organ system	Disease	Age of onset	Muscle weakness	Fever	Myalgia	Contractures	Gait abnormality	Neuropathy	Atrophy	Stiffness	Myoglobinuria	Other features	History	Physical Examination	Laboratory Findings	Creatine Kinase	Muscle Biopsy	Electromyogram

References

↑ Pease CT, Haugeberg G, Montague B; et al. (2009). "Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study". Rheumatology (Oxford). 48 (2): 123–7. doi:10.1093/rheumatology/ken343. PMID 18980958. Unknown parameter |month= ignored (help)
↑ Pease CT, Haugeberg G, Morgan AW, Montague B, Hensor EM, Bhakta BB (2005). "Diagnosing late onset rheumatoid arthritis, polymyalgia rheumatica, and temporal arteritis in patients presenting with polymyalgic symptoms. A prospective longterm evaluation". J. Rheumatol. 32 (6): 1043–6. PMID 15940765. Unknown parameter |month= ignored (help)
↑ Sørensen CD, Hansen LH, Hørslev-Petersen K (2010). "[Myositis as differential diagnosis in polymyalgia rheumatica]". Ugeskr. Laeg. (in Danish). 172 (42): 2899–900. PMID 21040663. Unknown parameter |month= ignored (help)
↑ Hopkinson ND, Shawe DJ, Gumpel JM (1991). "Polymyositis, not polymyalgia rheumatica". Ann. Rheum. Dis. 50 (5): 321–2. PMC 1004419. PMID 2042988. Unknown parameter |month= ignored (help)
↑ Myklebust G, Gran JT (1996). "A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis". Br J Rheumatol. 35 (11): 1161–8. PMID 8948307.
↑ Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
↑ Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
↑ Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
↑ Ohara N, Katada S, Yamada T, Mezaki N, Suzuki H, Suzuki A, Hanyu O, Yoneoka Y, Kawachi I, Shimohata T, Kakita A, Nishizawa M, Sone H (2016). "Fibromyalgia in a Patient with Cushing's Disease Accompanied by Central Hypothyroidism". Intern. Med. 55 (21): 3185–3190. doi:10.2169/internalmedicine.55.5926. PMC 5140872. PMID 27803417.

[pmid18980958-1] Pease CT, Haugeberg G, Montague B; et al. (2009). "Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study". Rheumatology (Oxford). 48 (2): 123–7. doi:10.1093/rheumatology/ken343. PMID 18980958. Unknown parameter |month= ignored (help)

[pmid15940765-2] Pease CT, Haugeberg G, Morgan AW, Montague B, Hensor EM, Bhakta BB (2005). "Diagnosing late onset rheumatoid arthritis, polymyalgia rheumatica, and temporal arteritis in patients presenting with polymyalgic symptoms. A prospective longterm evaluation". J. Rheumatol. 32 (6): 1043–6. PMID 15940765. Unknown parameter |month= ignored (help)

[pmid21040663-3] Sørensen CD, Hansen LH, Hørslev-Petersen K (2010). "[Myositis as differential diagnosis in polymyalgia rheumatica]". Ugeskr. Laeg. (in Danish). 172 (42): 2899–900. PMID 21040663. Unknown parameter |month= ignored (help)

[pmid2042988-4] Hopkinson ND, Shawe DJ, Gumpel JM (1991). "Polymyositis, not polymyalgia rheumatica". Ann. Rheum. Dis. 50 (5): 321–2. PMC 1004419. PMID 2042988. Unknown parameter |month= ignored (help)

[pmid8948307-5] Myklebust G, Gran JT (1996). "A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis". Br J Rheumatol. 35 (11): 1161–8. PMID 8948307.

[pmid1658649-6] Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.

[pmid16586492-7] Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.

[pmid16586493-8] Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.

[pmid27803417-9] Ohara N, Katada S, Yamada T, Mezaki N, Suzuki H, Suzuki A, Hanyu O, Yoneoka Y, Kawachi I, Shimohata T, Kakita A, Nishizawa M, Sone H (2016). "Fibromyalgia in a Patient with Cushing's Disease Accompanied by Central Hypothyroidism". Intern. Med. 55 (21): 3185–3190. doi:10.2169/internalmedicine.55.5926. PMC 5140872. PMID 27803417.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Polymyalgia rheumatica}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Polymyalgia_rheumatica]]
 {{CMG}}; {{AE}} {{AEL}}
@@ Line 7: / Line 7: @@
 ==Differentiating Polymyalgia Rheumatica from other Diseases==
-PMR must be differentiated from the following conditions:
+Polymyalgia rheumatica (PMR) must be differentiated from other conditions such as late onset [[rheumatoid arthritis]], [[polymyositis]], [[dermatomyositis]], [[fibromyalgia]], and [[remitting seronegative symmetrical synovitis with pitting edema]].<ref name="pmid18980958">{{cite journal |author=Pease CT, Haugeberg G, Montague B, ''et al.'' |title=Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study |journal=Rheumatology (Oxford) |volume=48 |issue=2 |pages=123–7 |year=2009 |month=February |pmid=18980958 |doi=10.1093/rheumatology/ken343 |url=}}</ref><ref name="pmid15940765">{{cite journal |author=Pease CT, Haugeberg G, Morgan AW, Montague B, Hensor EM, Bhakta BB |title=Diagnosing late onset rheumatoid arthritis, polymyalgia rheumatica, and temporal arteritis in patients presenting with polymyalgic symptoms. A prospective longterm evaluation |journal=J. Rheumatol. |volume=32 |issue=6 |pages=1043–6 |year=2005 |month=June |pmid=15940765 |doi= |url=}}</ref><ref name="pmid21040663">{{cite journal |author=Sørensen CD, Hansen LH, Hørslev-Petersen K |title=[Myositis as differential diagnosis in polymyalgia rheumatica] |language=Danish |journal=Ugeskr. Laeg. |volume=172 |issue=42 |pages=2899–900 |year=2010 |month=October |pmid=21040663 |doi= |url=}}</ref><ref name="pmid2042988">{{cite journal |author=Hopkinson ND, Shawe DJ, Gumpel JM |title=Polymyositis, not polymyalgia rheumatica |journal=Ann. Rheum. Dis. |volume=50 |issue=5 |pages=321–2 |year=1991 |month=May |pmid=2042988 |pmc=1004419 |doi= |url=}}</ref>
-* [[Rheumatoid arthritis]]: PMR and late onset [[rheumatoid arthritis]] (RA) can initially present with similar clinical features like [[synovitis]].  These patients are treated initially as PMR with [[glucocorticoids]].  RA treatment is started when there is no improvement or when it evolves into characteristic RA or when there is a persistently raised plasma viscosity.<ref name="pmid18980958">{{cite journal |author=Pease CT, Haugeberg G, Montague B, ''et al.'' |title=Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study |journal=Rheumatology (Oxford) |volume=48 |issue=2 |pages=123–7 |year=2009 |month=February |pmid=18980958 |doi=10.1093/rheumatology/ken343 |url=}}</ref> <ref name="pmid15940765">{{cite journal |author=Pease CT, Haugeberg G, Morgan AW, Montague B, Hensor EM, Bhakta BB |title=Diagnosing late onset rheumatoid arthritis, polymyalgia rheumatica, and temporal arteritis in patients presenting with polymyalgic symptoms. A prospective longterm evaluation |journal=J. Rheumatol. |volume=32 |issue=6 |pages=1043–6 |year=2005 |month=June |pmid=15940765 |doi= |url=}}</ref>
-* [[Polymyositis]] and [[dermatomyositis]]: Patients with [[dermatomyositis]] or [[polymyositis]] present with tenderness and weakness of proximal muscles, while PMR patients present with pain and stiffness. This differentiation between these entities may be difficult in elderly patients. Proper history, complete physical examination, [[ESR]], [[creatine kinase]] levels and [[muscle biopsy]] help in establishing the proper diagnosis.<ref name="pmid21040663">{{cite journal |author=Sørensen CD, Hansen LH, Hørslev-Petersen K |title=[Myositis as differential diagnosis in polymyalgia rheumatica] |language=Danish |journal=Ugeskr. Laeg. |volume=172 |issue=42 |pages=2899–900 |year=2010 |month=October |pmid=21040663 |doi= |url=}}</ref> <ref name="pmid2042988">{{cite journal |author=Hopkinson ND, Shawe DJ, Gumpel JM |title=Polymyositis, not polymyalgia rheumatica |journal=Ann. Rheum. Dis. |volume=50 |issue=5 |pages=321–2 |year=1991 |month=May |pmid=2042988 |pmc=1004419 |doi= |url=}}</ref>
-* [[Malignancy]] (such as [[myeloma]]): Patients with [[malignancy]] sometimes present with PMR like symptoms and have  poor response to [[steroid]] therapy.<ref name="pmid3774196">{{cite journal |author=Manganelli P, Borghi L, Coruzzi P, Novarini A, Ambanelli U |title=[Paraneoplastic polymyalgia rheumatica. Case contribution] |language=Italian |journal=Minerva Med. |volume=77 |issue=38 |pages=1739–41 |year=1986 |month=October |pmid=3774196 |doi= |url=}}</ref> This is in fact paraneoplastic syndrome presenting as PMR.<ref name="pmid19562970">{{cite journal |author=Kwiatkowska B, Filipowicz-Sosnowska A |title=[Polymyalgia rheumatica mimicking neoplastic disease--significant problem in elderly patients] |language=Polish |journal=Pol. Arch. Med. Wewn. |volume=118 Suppl |issue= |pages=47–9 |year=2008 |pmid=19562970 |doi= |url=}}</ref>
-*[[Fibromyalgia]]: [[Fibromyalgia]] occurs in age groups 20-50 years.  Patients have characteristic tender points. Unlike PMR, the active phase proteins and [[ESR]] are normal.
-*[[Hyperparathyroidism]]: [[Hyperparathyroidism]] presents with proximal stiffness and bone pain with elevated [[parathyroid hormone]] levels and often raised [[calcium]] levels without elevation of [[ESR]] levels.
-* Chronic infection ([[subacute bacterial endocarditis]] ([[SBE]])): Rheumatologic symptoms seen in [[infective endocarditis]] can present as a clinical picture suggestive of [[polymyalgia rheumatica]] hindering the correct diagnosis.<ref name="pmid16859595">{{cite journal |author=Auzary C, Le Thi Huong D, Delarbre X, ''et al.'' |title=Subacute bacterial endocarditis presenting as polymyalgia rheumatica or giant cell arteritis |journal=Clin. Exp. Rheumatol. |volume=24 |issue=2 Suppl 41 |pages=S38–40 |year=2006 |pmid=16859595 |doi= |url=}}</ref>
-* [[Hypothyroidism]]: Patients with hypothyroidism muscle and joint pain and weakness similar to [[PMR]]. Delayed relaxation of deep tendon reflexes is seen in [[hypothyroidism]] with elevated [[TSH]] levels and low [[T4]] levels.
-*[[Remitting seronegative symmetrical synovitis with pitting edema]] ([[RS3PE]]): [[RS3PE]] presents with symmetrical [[synovitis]] and [[pitting edema]], usually in patients over 50 years of age and lack [[rheumatoid factor]]. Unlike PMR, the symptoms commonly manifest distally.
 ===Differentiating polymyalgia rheumatica on the basis of fatigue and chronic pain===
-{| class="wikitable"
+{|
-!Disease
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
-!Differentiating signs and symptoms
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Differentiating signs and symptoms
-!Diagnostic findings
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diagnostic findings
 |-
-|[[Polymyalgia rheumatica]]
+! align="center" style="background:#DCDCDC;" + |[[Polymyalgia rheumatica]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * Older at onset
 * Generalized [[stiffness]]
-|
+| align="left" style="background:#F5F5F5;" + |
-* An elevated [[erythrocyte sedimentation rate]] ([[ESR]]) OR [[C-reactive protein]] (CRP)
+* Elevated [[ESR]] or [[CRP]]
 * Response to [[corticosteroids]]
 |-
-|[[Fibromyalgia]]
+! align="center" style="background:#DCDCDC;" + |[[Fibromyalgia]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * Symptoms have been present at a similar level for at least 3 months.
 * Chronic [[musculoskeletal pain]] with multiple tender points
@@ Line 45: / Line 29: @@
 * [[Headaches]]
 * [[Sleep disorder]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *All lab tests are normal
 |-
-|[[Rheumatoid arthritis]]
+! align="center" style="background:#DCDCDC;" + |[[Rheumatoid arthritis]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * Multiple [[joint swelling]]
 * Morning [[stiffness]]
 * [[Rheumatoid nodules]]
-|
+| align="left" style="background:#F5F5F5;" + |
-* [[Rheumatoid factor|RF]] or [[Anti-citrullinated protein antibody|anti-cyclic citrullinated protein (CCP) antibody]] is positive.
+* Positive [[Rheumatoid factor|RF]] or [[Anti-citrullinated protein antibody|anti-cyclic citrullinated protein (CCP) antibody]]
-* Markers of systemic inflammation ([[ESR]], [[CRP]]) are typically elevated.
+* Elevated [[ESR]] or [[CRP]]
 |-
-|[[SLE]]
+! align="center" style="background:#DCDCDC;" + |[[SLE]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * [[Maculopapular rash]]
 * Multi-system involvement
-|
+| align="left" style="background:#F5F5F5;" + |
 *Positive anti-Smith [[antibodies]]
 |-
-|[[Chronic fatigue syndrome]]
+! align="center" style="background:#DCDCDC;" + |[[Chronic fatigue syndrome]]
-|Fatigue plus 4 of the following symptoms:
+| align="left" style="background:#F5F5F5;" + |[[Fatigue]] plus 4 of the following symptoms:
 *Short-term [[memory loss]]
 *[[Sore throat]]
@@ Line 75: / Line 59: @@
 *[[Insomnia]]
 *[[Malaise]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *Diagnosis of exclusions
 *Symptoms must present for more than 6 months
 |-
-|[[Spondyloarthritis]]
+! align="center" style="background:#DCDCDC;" + |[[Spondyloarthritis]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * [[Axial skeleton|Axial skeletal]] pain and [[stiffness]]
 * Restricted spinal motion
-|
+| align="left" style="background:#F5F5F5;" + |
 * Elevated [[ESR]] or [[CRP]]
 * Negative [[RF]]
 * [[Bamboo spine]] on [[x-ray]]
 |-
-|[[Osteoarthritis]]
+! align="center" style="background:#DCDCDC;" + |[[Osteoarthritis]]
-|
+| align="left" style="background:#F5F5F5;" + |
 * Localized [[joint pain]]
-* Restricted to affect joints
+* Restricted to affect [[Joint|joints]]
 * Older at onset
-|
+| align="left" style="background:#F5F5F5;" + |
-* [[X-ray]] of the involved joints demonstrate degenerative changes
+* Degenerative joint changes on [[X-rays|x-ray]]
 |-
-|[[Hypothyroidism]]
+! align="center" style="background:#DCDCDC;" + |[[Hypothyroidism]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *Systemic symptoms such as [[weight gain]], [[constipation]], [[dry skin]]
-*[[Myalgia|Muscular aching]] and prominent [[fatigue]] that improves on replacement of [[thyroid hormone]].
+*[[Myalgia|Muscular aching]]
-|
+*Prominent [[fatigue]]
-*[[TSH]] is elevated and free [[T4]] is low.
+| align="left" style="background:#F5F5F5;" + |
+*Elevated [[TSH]]
+*Low free [[T4]]
 |-
-|Myopathaies ([[polymyositis]] and [[dermatomyositis]])
+! align="center" style="background:#DCDCDC;" + |[[Polymyositis and dermatomyositis]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *Pelvic and shoulder girdle [[muscle weakness]]
 *[[Rash]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *[[Muscle biopsy]] confirms the diagnosis
 *Elevated [[CPK|CPK enzyme]]
 |-
-|[[Neuropathy]]
+! align="center" style="background:#DCDCDC;" + |[[Neuropathy]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *[[Numbness]] and [[tingling]]
 *[[Paresthesia]]
-|
+| align="left" style="background:#F5F5F5;" + |
 *Abnormal [[EMG]]
 |}
-=== Differentiating polymyalgia rheumatica from other causes of myopathy ===
+=== Differentiating polymyalgia rheumatica from other causes of inflammatory myopathy ===
+{|
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
-{| class="wikitable"
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
-! rowspan="3" |Disease
+! colspan="12" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
-! colspan="9" |Symptoms
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |History
-! rowspan="3" |History
+! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical
-! rowspan="3" |Physical
 Examination
-! colspan="4" |Diagnosis
+! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
 |-
-! rowspan="2" |Age of onset
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Age of onset
-! colspan="2" |Muscle weakness
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle weakness
-! rowspan="2" |Fever
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
-! rowspan="2" |Muscle pain
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myalgia
-! rowspan="2" |Gait abnormality
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Contractures
-! rowspan="2" |Neuropathy
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gait abnormality
-! rowspan="2" |Myoglobinuria
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Neuropathy
-! rowspan="2" |Other features
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Atrophy
-! rowspan="2" |Laboratory Findings
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stiffness
-! rowspan="2" |Creatine Kinase
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myoglobinuria
-! rowspan="2" |Muscle Biopsy
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
-! rowspan="2" |Electromyogram
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Laboratory Findings
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Creatine Kinase
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle Biopsy
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
 |-
-!Proximal
+! rowspan="5" style="background:#DCDCDC;" align="center" + |Inflammatory/ Rheumatologic
-!DIstal
+! style="background:#DCDCDC;" align="center" + |[[Polymyalgia rheumatica|Polymyalgia Rheumatica]]<ref name="pmid8948307">{{cite journal| author=Myklebust G, Gran JT| title=A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis. | journal=Br J Rheumatol | year= 1996 | volume= 35 | issue= 11 | pages= 1161-8 | pmid=8948307 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8948307  }}</ref>
-|-
+| style="background:#F5F5F5;" align="center" + |50s
-! colspan="16" |Medications
+| style="background:#F5F5F5;" align="center" + |Diffuse
-|-
+| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-|Corticosteroids
+| style="background:#F5F5F5;" align="center" + | +
-|
+| style="background:#F5F5F5;" align="center" + | −
-* Variable
+| style="background:#F5F5F5;" align="center" + | −
-|<nowiki>+</nowiki>
+| style="background:#F5F5F5;" align="center" + | −
-|<nowiki>-</nowiki>
+| style="background:#F5F5F5;" align="center" + |−
-|<nowiki>-</nowiki>
+| style="background:#F5F5F5;" align="center" + | +
-|<nowiki>+</nowiki>
+| style="background:#F5F5F5;" align="center" + | −
-|<nowiki>-</nowiki>
+| style="background:#F5F5F5;" align="left" + |
-| -
+* [[Weight loss]]
-|<nowiki>-</nowiki>
+| style="background:#F5F5F5;" align="left" + |
-|
+* History of joints stiffness, worse in the morning
-* Central obesity
+| style="background:#F5F5F5;" align="left" + |
-* Excessive [[sweating]]
+* Restricted shoulder motion
-* [[Insomnia]]
+| style="background:#F5F5F5;" align="left" + |
-* Reduced [[libido]]
+* '''↑↑''' [[Erythrocyte sedimentation rate|ESR]]
-* [[Amenorrhoea|Amenorrhea]]
+* '''↑↑''' [[C-reactive protein|CRP]]
-* [[Infertility]]
+| style="background:#F5F5F5;" align="left" + |
-* Psychological disturbances
-|
-*+  History of medications
-|
-* Facial and sphincter muscles usually are spared
-|
-* + ACTH Stimulation test
-* 24-hour urine [[cortisol]]
-* Low dose [[dexamethasone]] suppression test
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|-
-|Statins
-|
-* 60+
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-| -
-|<nowiki>-/+(rhabdomyolysis)</nowiki>
-|
-* N/A
-|
-* Positive medication history
-|
-* Tenderness
-* Muscle aches
-|
-* '''↑↑''' liver enzymes
-|
-* '''↑↑'''
-|
-* Necrosis
-* Degeneration, and regeneration of fibers
-* Phagocytic infiltration
-|<nowiki>-</nowiki>
-|-
-|Alcohol
-|
-* Variable
-|      '''+'''
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>+/-</nowiki>
-|<nowiki>-</nowiki>
-|
-* Swelling
-* Tender
-* Erythema and induration
-|
-* Alcohol intoxication
-|
-* Change in mental status
-* Telangiectasia
-* Peripheral neuropathy
-|
-*  nonspecific and are normal in many patients
-|
-* Normal or '''↑↑'''
-|
-* Normal
-|
-* Normal
-|-
-! colspan="16" |Endocrine
-|-
-|Cushing's disease
-|
-* 25 -45
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|
-* Decreased libido
-* Obesity/weight gain
-* Plethora
-* Round face
-* Menstrual changes
-* Hirsutism
-* Hypertension
-* Ecchymoses
-* Lethargy, depression
-* Dorsal fat pad
-* Abnormal glucose tolerance
-|
-* N/A
-|
-* Facial and sphincter muscles usually are spared
-* Overweight
-* Straie
-* Moon face
-* HTN
-* Hyperpigmentation
-|
-* + ACTH Stimulation test
-* 24-hour urine [[cortisol]]
-* Low dose [[dexamethasone]] suppression test
-|Normal
-|
-* Atrophy of type 2 muscle fibers, especially type 2B
-|Normal
-|-
-|Adrenal insufficiency
-|
-* 30-50 years
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|
-* Signs of glucocorticoid, mineralocorticoid, and, androgen deficiency.
-|
-* Signs of [[postural hypotension]]
-* History of [[tuberculosis]]
-* History of [[malignancy]]
-* History of other [[autoimmune disease]]
-|
-* Hypotension
-* Hyperpigmentation
-* Auricular-cartilage calcification
-* Vitiligo
-|
-* Electrolyte abnormalities
-* Hypoglycemia
-|
-* Normal
-|
-* Normal
-|
-* Normal
-|-
-|Hyperaldosteronism with myopathy
-|
-* 50
-|<nowiki>+</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-Rhabdomyolysis
-|
-* Palpitations
-* Hypertension
-|
-* Episodes of heart beats
-|
-* Hyperpigmentation
-|
-* Hypokalemia
-|
 * Normal
-|
+| style="background:#F5F5F5;" align="left" + |
 * Normal
-|
+| style="background:#F5F5F5;" align="left" + |
 * Normal
 |-
-|Hyperthyroidism
+! style="background:#DCDCDC;" align="center" + |[[Dermatomyositis]]<ref name="pmid1658649">{{cite journal| author=Dalakas MC| title=Polymyositis, dermatomyositis and inclusion-body myositis. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 21 | pages= 1487-98 | pmid=1658649 | doi=10.1056/NEJM199111213252107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1658649  }}</ref>
-|
+| style="background:#F5F5F5;" align="center" + |40s−50s<br>Can affect children
-* 40
+| style="background:#F5F5F5;" align="center" + |Proximal
-|<nowiki>+</nowiki>
+| style="background:#F5F5F5;" align="center" + | +
-|<nowiki>-</nowiki>
+| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
+| style="background:#F5F5F5;" align="center" + | −
-|<nowiki>-</nowiki>
+| style="background:#F5F5F5;" align="center" + | −
-|<nowiki>-</nowiki>
+| style="background:#F5F5F5;" align="center" + | −
-|<nowiki>-</nowiki>
+| style="background:#F5F5F5;" align="center" + |−
-|<nowiki>+</nowiki>
+| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-|
+| style="background:#F5F5F5;" align="center" + | −
-* Signs of hyperthyroidism
+| style="background:#F5F5F5;" align="left" + |
-|
+* [[Rash]]
-* Sweating
+* [[Dyspnea]]
-* Tremor'
+* [[Weight loss]]
-* H/o of weight loss
+* [[Cough]]
-|
+| style="background:#F5F5F5;" align="left" + |
-* Sweating
+* [[Viral infections]]
-* Tremor'
+* [[Cancer]]
-* Swelling on neck examination
+| style="background:#F5F5F5;" align="left" + |
-|
-* Decreased TSH
-|
-* '''↑↑'''
-|
-* Non specific
-|
-* Myotonic
-|-
-|Hypothyroidism
-|
-* >55
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-| -
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>+ Rhabdomyolysis</nowiki>
-|
-*  Signs of hypothyroidism
-|
-* H/o weight gain
-|
-* Myoedema
-* Muscle pseudohypertrophy
-|
-* Increased TSH
-|
-* '''↑↑'''
-|
-* Nonspecific
-|
-* Normal
-|-
-|Diabetic infraction
-|
-* 45
-| +
-| -
-| +
-| +
-| -
-| +
-| -
-|
-* Cramps
-* Sudden onset of pain
-* Anterior thigh muscles are most commonly involved
-*
-|
-* H/O long standing diabetes
-|
-* Swelling
-* Tenderness
-|
-* Elevation of the erythrocyte sedimentation rate
-* Leukocytosis
-|
-* Normal
-|
-* Necrosis
-* Edema
-|
-* Normal
-|-
-! colspan="16" |Inflammatory / Rheumatologic
-|-
-|Dermatomyositis<ref name="pmid1658649">{{cite journal| author=Dalakas MC| title=Polymyositis, dermatomyositis and inclusion-body myositis. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 21 | pages= 1487-98 | pmid=1658649 | doi=10.1056/NEJM199111213252107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1658649  }}</ref>
-|
-* 40s-50s
-* Can affect childreen
-|<nowiki>+</nowiki>
-| -
-| +
-|<nowiki>+</nowiki>
-| -
-| -
-| -
-|
-* Rash
-* Dyspnea
-* Weight loss
-* Cough
-|
-|
 * Heliotrope rash on face and hands
-* Telangectasia
+* [[Telangiectasia]]
-* Erythema
+* [[Erythema]]
 * Mechanic's hands
-* Gottron's sign ( violaceous scaly eruption )
+* [[Gottron's papules|Gottron's sign]] ( violaceous scaly eruption )
-| rowspan="2" |
+| style="background:#F5F5F5;" align="left" + |
-* '''↑↑''' ESR
+* '''↑↑''' [[Erythrocyte sedimentation rate|ESR]]
-* '''↑↑''' CRP
+* '''↑↑''' [[C-reactive protein|CRP]]
-|
+| style="background:#F5F5F5;" align="left" + |
 * '''↑↑'''
-|
+| style="background:#F5F5F5;" align="left" + |
 * Perimysial mononuclear infiltrate
-| rowspan="2" |
+| rowspan="2" style="background:#F5F5F5;" align="left" + |
-* Muscle inflammation and damage
+* [[Myopathic]]
 |-
-|Polymyositis<ref name="pmid16586492">{{cite journal| author=Dalakas MC| title=Polymyositis, dermatomyositis and inclusion-body myositis. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 21 | pages= 1487-98 | pmid=1658649 | doi=10.1056/NEJM199111213252107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1658649  }}</ref>
+! style="background:#DCDCDC;" align="center" + |[[Polymyositis]]<ref name="pmid16586492">{{cite journal| author=Dalakas MC| title=Polymyositis, dermatomyositis and inclusion-body myositis. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 21 | pages= 1487-98 | pmid=1658649 | doi=10.1056/NEJM199111213252107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1658649  }}</ref>
-|
+| style="background:#F5F5F5;" align="center" + |> 18 years
-* > 18 years
+| style="background:#F5F5F5;" align="center" + |Proximal
-|<nowiki>+</nowiki>
+| style="background:#F5F5F5;" align="center" + | +
-| -
+| style="background:#F5F5F5;" align="center" + | +
-| +
+| style="background:#F5F5F5;" align="center" + | −
-| +
+| style="background:#F5F5F5;" align="center" + | −
-| -
+| style="background:#F5F5F5;" align="center" + | −
-| -
+| style="background:#F5F5F5;" align="center" + |−
-| -
+| style="background:#F5F5F5;" align="center" + |<nowiki>+</nowiki>
-|
+| style="background:#F5F5F5;" align="center" + | −
-* Similar to dermatomyositis without mucous and skin involvement
+| style="background:#F5F5F5;" align="left" + |
-|
+* Similar to [[dermatomyositis]] without [[mucous]] and [[skin]] involvement
+| style="background:#F5F5F5;" align="left" + |
 * N/A
-|
+| style="background:#F5F5F5;" align="left" + |
 * N/A
-|
+| style="background:#F5F5F5;" align="left" + |
+* '''↑↑''' [[Erythrocyte sedimentation rate|ESR]]
+* '''↑↑''' [[C-reactive protein|CRP]]
+| style="background:#F5F5F5;" align="left" + |
 * '''↑↑'''
-|
+| style="background:#F5F5F5;" align="left" + |
 * Endomysial mononuclear infiltrate
 * Patchy necrosis
 |-
-|Inclusion body myositis<ref name="pmid16586493">{{cite journal| author=Dalakas MC| title=Polymyositis, dermatomyositis and inclusion-body myositis. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 21 | pages= 1487-98 | pmid=1658649 | doi=10.1056/NEJM199111213252107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1658649  }}</ref>
+! style="background:#DCDCDC;" align="center" + |Inclusion body [[myositis]]<ref name="pmid16586493">{{cite journal| author=Dalakas MC| title=Polymyositis, dermatomyositis and inclusion-body myositis. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 21 | pages= 1487-98 | pmid=1658649 | doi=10.1056/NEJM199111213252107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1658649  }}</ref>
-|
+| style="background:#F5F5F5;" align="center" + |50s
-* 50s
+| style="background:#F5F5F5;" align="center" + |Proximal<br>&<br>distal
-|<nowiki>+</nowiki>
+| style="background:#F5F5F5;" align="center" + |−
-| +
+| style="background:#F5F5F5;" align="center" + |−
-|
+| style="background:#F5F5F5;" align="center" + | −
-|
+| style="background:#F5F5F5;" align="center" + |−
-|
+| style="background:#F5F5F5;" align="center" + |−
-|
+| style="background:#F5F5F5;" align="center" + |−
-|
+| style="background:#F5F5F5;" align="center" + |−
-|
+| style="background:#F5F5F5;" align="center" + |−
-|
+| style="background:#F5F5F5;" align="left" + |
-|
+* [[Dysphagia]]
-|
+* Asymmetric weakness
-|
+| style="background:#F5F5F5;" align="left" + |
+* [[Retrovirus]] (most common)
+| style="background:#F5F5F5;" align="left" + |
+* N/A
+| style="background:#F5F5F5;" align="left" + |
+* Antibodies to cytoplasmic 5'−nucleotidase
+| style="background:#F5F5F5;" align="left" + |
 * '''↑↑'''
-|
+| style="background:#F5F5F5;" align="left" + |
-|
+* [[Inflammatory cells]]
+* Invading [[muscle cells]]
+* Vacuolar degeneration
+* Inclusions or plaques
+| style="background:#F5F5F5;" align="left" + |
+* [[Neurogenic]]
 |-
-|Fibomyalgia
+! style="background:#DCDCDC;" align="center" + |[[Fibromyalgia]]<ref name="pmid27803417">{{cite journal |vauthors=Ohara N, Katada S, Yamada T, Mezaki N, Suzuki H, Suzuki A, Hanyu O, Yoneoka Y, Kawachi I, Shimohata T, Kakita A, Nishizawa M, Sone H |title=Fibromyalgia in a Patient with Cushing's Disease Accompanied by Central Hypothyroidism |journal=Intern. Med. |volume=55 |issue=21 |pages=3185–3190 |date=2016 |pmid=27803417 |pmc=5140872 |doi=10.2169/internalmedicine.55.5926 |url=}}</ref>
-|
+| style="background:#F5F5F5;" align="center" + |40−50s
-* 40-50s
+| style="background:#F5F5F5;" align="center" + |Generalized
-|
+| style="background:#F5F5F5;" align="center" + |−
-+
+| style="background:#F5F5F5;" align="center" + | −
-|<nowiki>-</nowiki>
+| style="background:#F5F5F5;" align="center" + | −
-|<nowiki>-</nowiki>
+| style="background:#F5F5F5;" align="center" + | −
-| -
+| style="background:#F5F5F5;" align="center" + | +
-| -
+| style="background:#F5F5F5;" align="center" + |−
-| ++
+| style="background:#F5F5F5;" align="center" + |−
-| -
+| style="background:#F5F5F5;" align="center" + | −
-|
+| style="background:#F5F5F5;" align="left" + |
-* Anxiety or depression features
+* [[Anxiety]] or depression features
-* Fatigue
+* [[Fatigue]]
 * Sleep disturbance
-* Numbness
+* [[Numbness]]
-* Muscle spasms
+* [[Muscle spasms]]
-|
+| style="background:#F5F5F5;" align="left" + |
-* History of depressive disorder
+* History of [[depression]]
-|
+| style="background:#F5F5F5;" align="left" + |
-* Tenderness in the soft tissue anatomical location
+* [[Tenderness]] in the soft tissue anatomical location
-|
+| style="background:#F5F5F5;" align="left" + |
 * Normal
-|
+| style="background:#F5F5F5;" align="left" + |
 * Normal
-|
+| style="background:#F5F5F5;" align="left" + |
 * Normal
-|
+| style="background:#F5F5F5;" align="left" + |
 * Normal
 |-
-|Polymyalgia Rheumatica<ref name="pmid8948307">{{cite journal| author=Myklebust G, Gran JT| title=A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis. | journal=Br J Rheumatol | year= 1996 | volume= 35 | issue= 11 | pages= 1161-8 | pmid=8948307 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8948307  }}</ref>
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
-|
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
-* 50s
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Age of onset
-|<nowiki>+</nowiki>
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle weakness
-|<nowiki>-</nowiki>
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
-|<nowiki>+</nowiki>
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myalgia
-| +
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Contractures'''
-| -
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gait abnormality
-| -
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Neuropathy
-| -
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Atrophy
-|
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Stiffness
-* Weight loss
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Myoglobinuria
-|
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
-* History of joints stiffness which is worse in the morning
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |History
-|
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical
-* Restricted shoulder motion
+Examination
-|
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Laboratory Findings
-* '''↑ CRP'''
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Creatine Kinase
-* '''↑ ESR'''
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Muscle Biopsy
-|
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
-* Normal
-|
-* Normal
-|
-* Normal
-|-
-! colspan="16" |Genetic
-|-
-|Becker muscular dystrophy
-|<13yrs
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|
-* Milder form of Duchenne
-|
-* Growth delay
-* Age of onset of symptoms is much delayed than duchenne
-|
-|
-* Decreased amount of [[dystrophin]].
-|
-* ↑↑
-| rowspan="2" |
-** Muscle fibril degeneration, regeneration
-** Isolated fiber hypertrophy
-** Muscle replacement with fat and connective tissue
-| rowspan="2" |
-* Myopathic changes
-|-
-|Duchenne muscular dystrophy
-|<13 yrs
-| +
-| -
-| -
-| -
-|<nowiki>+</nowiki>
-| -
-| -
-|
-* Calf psedohypertrophy
-* Cardiomyopathy
-* Kyphoscoliosis
-* Cognitive impairment
-|
-* Early onset
-*
-|
-* +Grower sign
-|
-* Errors in the Xp21 gene.
-* Absence of [[dystrophin]].
-|
-* '''↑↑'''
-|-
-|Limb-girdle muscular dystrophies
-|<15 yrs
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|
-* Calf hypertrophy
-* Scapular winging
-* Cardiomyopathy
-* Cardiac arrhythmias
-* Respiratory muscle weakness
-|
-* Autosomal dominant
-|
-*
-|
-* LMNA gene
-* CAV3 gene
-*
-|
-* '''↑↑'''
-|
-* -
-|
-|-
-|Myotonic dystrophy type 1
-|
-|<nowiki>+</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|
-* Myotonia
-* Cataracts
-* Diabetes mellitus
-* Frontal balding
-* Cardiac arrhythmias
-* Cholecystitis
-* Pregnancy
-* Eyelid ptosis
-|
-|
-|
-|
-|
-|
-|-
-! colspan="16" |Infectious
-|-
-|Lyme disease
-|Variable
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-| +
-|<nowiki>+</nowiki>
-| +/-
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|
-* Erythema Migrans
-* Flu-like symptoms
-* [[Lyme arthritis]]
-* [[Neurological]] manifestations
-|
-* + Tick bite
-* Hiking/Tip
-|
-* Target-like [[lesions]]
-* HSM
-|
-* Clinical diagnosis
-* +Serology
-|
-* -
-|
-* -
-|
-* -
-|-
-|Infulenza
-|Variable
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-| +
-|<nowiki>+</nowiki>
-| +
-|<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|
-* Fever
-* Malaise
-* Rhinorrhea
-* Muscle pain worse with movement
-|
-*
-|
-* Muscle weakness, tenderness, and swelling.
-|
-* '''↑↑''' Liver enzymes
-* +PCR
-|
-* '''↑↑'''
-|
-* -
-|
-* -
-|-
-|Polio
-|<5 yrs
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-| -
-|<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|
-* Asymmetrical [[paralysis]]
-* [[Muscle atrophy]]
-* [[Tremors]]
-* [[Skeletal]] deformities
-|
-|
-* Normal
-* [[Meningeal signs]]
-* Asymmetrical flaccid paralysis
-* Pharyngeal paralysis
-|
-* Isolation from [[pharyngeal]]<nowiki/>secretions, CSF
-* +Serology
-|
-* -
-|
-* -
-|
-* Neurological pattern
-|-
-|Syphilis
-|Variable
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|
-* [[Chancre]]
-* Lymphadenopathy
-* Condylomata lata
-* Neuro syphilis
-* Cardiovascular syphilis
-|
-* History of risk factors (MSM, unprotected sex, multiple sex partners)
-|
-* Non-tender [[chancre]] in primary syphilis.
-* Followed by [[rash]]
-* Generalized [[lymphadenopathy]] in secondary syphilis
-|
-* Darkfield examinations
-* VDRL
-* RPR
-* [[FTA-ABS]]
-|
-* -
-|
-* -
-|
-* -
-|-
-|Pyomyositis
-|Variable
-|<nowiki>+/-</nowiki>
-|<nowiki>+/-</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|
-* Fever
-* Malaise
-* Psoas abscess
-|
-* Immunocopmprimised
-|
-** Muscles are painful, swollen, tender, and indurated.
-** Depending on the site of involvement, it may mimic appendicitis (psoas muscle), septic arthritis of the hip (iliacus muscle), or epidural abscess (piriformis muscle).
-|
-* Leukocytosis
-* Elevated ESR
-|
-* -
-|
-* -
-|
-* -
-|-
-! colspan="16" |Neurologic
-|-
-|ALS
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-* Both upper and lower motor neuron signs
-|
-|
-* Normal
-|
-* Nonspecific findings of chronic denervation with reinnervation
-|
-* Neuropathic
-|-
-|Stroke
-|
-* >65
-|<nowiki>+</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|
-* Dysphagia
-* Unilateral/Bilateral weakness
-|
-* H/o HTN, dyslipedemia DM
-|
-* Weakness of the involved arm
-*
-|
-*
-|
-* Normal
-|
-* Normal
-|
-* Neuropathic
-|-
-|GBS
-|
-* 18  -350
-| -
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|
-* Ascending paralysis
-|
-* Precedes a gastrointestinal disease
-|
-* Weakness of lower extremities followed by upper extremities
-|
-* Cytologic albumin ratio
-|
-* Normal
-|
-* Normal
-|
-* Neuropathic
-|-
-|Multiple Sclerosis
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-! colspan="16" |Neuro-muscular
-|-
-|Botulisim
-|
-|<nowiki>-</nowiki>
-|<nowiki>+</nowiki>
-|
-|
-|
-|
-|
-|
-|
-* H/0 Food exposure and air
-|
-|
-|
-|
-|
-|-
-|Lambert-Eaton myaes
-|
-|<nowiki>+</nowiki>
-|<nowiki>+</nowiki>
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|Myasthenia gravis
-|
-|<nowiki>+</nowiki>
-|<nowiki>+</nowiki>
-|
-|
-|
-|
-|
-|
-* Ocular
-* Bulbar
-* Limb weakness
-* Isolated neck, limbs and respiratory weakness
-|
-|
-|
-|
-|
-|
-|-
-! colspan="16" |Paraneoplastic
-|-
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-! colspan="16" |Metabolic
-|-
-|Glycogen storage disease
-|
-* Variable
-|<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|
-* AR
-* Faituge
-* Hypoglycemia
-|
-* Exercise intolerance
-|
-* Hypotonia
-* Hepatomeagly
-|
-* Lactic acidosis
-* Elevated liver enzymes
-* [[Ketosis]]
-|
-* '''↑↑'''
-|
-* Normal
-|
-* Normal
-|-
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |}
 ==References==
 {{reflist|2}}
-{{WH}}
-{{WS}}
+[[Category:Medicine]]
-[[Category:Disease]]
 [[Category:Rheumatology]]
+[[Category:Up-To-Date]]

Differentiating Polymyalgia rheumatica from other diseases: Difference between revisions

Latest revision as of 21:23, 29 July 2020

Overview

Differentiating Polymyalgia Rheumatica from other Diseases

Differentiating polymyalgia rheumatica on the basis of fatigue and chronic pain

Differentiating polymyalgia rheumatica from other causes of inflammatory myopathy

References

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