New-onset of polymyalgia rheumatica in an elderly patient with calcium pyrophosphate deposition (CPPD) disease.
Kiysohi Migita, Toshiyuki Tsurumoto, Haruki Matsumoto et al.
✦ AI-curated · Sources linked
Case in brief
An 87-year-old woman presented with fever and knee pain. Calcium pyrophosphate crystals in synovial fluid supported a diagnosis of CPPD disease, and NSAIDs resolved her knee arthritis and inflammatory signs. Three weeks after the initial knee symptoms, fever recurred with shoulder-region myalgia and morning stiffness. Ultrasonography showed bilateral long-head biceps tenosynovitis, and she met the EULAR/ACR provisional classification criteria for PMR, diagnosed as overlapping with CPPD disease. Her symptoms resolved with steroid therapy.
What made this case unusual
PMR emerged after the initial CPPD-associated knee arthritis had improved, with bilateral long-head biceps tenosynovitis on ultrasonography helping support the additional diagnosis.
Diagnostic / clinical pearl
In an older patient with CPPD disease, a changing or atypical inflammatory course accompanied by shoulder myalgia and morning stiffness should prompt consideration of overlapping PMR.