Q. My father gets intense pain in thighs and shoulder girdle. Please help.

Answered by
Dr. Naval Mendiratta
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on May 16, 2020

Hello doctor,

My 85-year-old father had mild pain in his thighs and shoulder girdle for two months which intensified in the past two weeks to a point that he could not get up from his bed. He was started on oral steroids 30 mg once daily for the past three days and has shown a 40% response but cannot stand. Blood tests were done yesterday showing normal serum electrolytes, bilirubin, TSH, and CBC with some iron deficiency.

Raised values are CPK - 272, BUN - 50, SGOT - 50, SGPT - 100, and leucocytes - 29000. His Hb is 9 and eosinophilia 42 since before. Kindly suggest the diagnosis.

Dr. Naval Mendiratta

Rheumatology
#

Hello,

Welcome to icliniq.com.

Well as per your history, it does look.like a diagnosis of polymyalgia rheumatica. I would like to ask you a few more queries related to his illness. When is the pattern of pain more mornings or evenings? Does he experience morning stiffness as well? Any history of weight loss or appetite loss? Any history of jaw pain or headache or fever? Do you have his reports of ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), rheumatoid factor available? As they are the most important to monitor and diagnose. Did they do any scans of the chest and abdomen?

As of now the reports do not seem very great with high leukocyte count and low Hb. Diagnosis of polymyalgia rheumatica looks certain but we should rule out any underlying trigger.


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Thank you doctor,

Pain is reduced. No specific stiffness, weight, and appetite are fine. I have attached some blood reports. ESR - 72, CRP - 38. ANA is negative and x-ray are not possible at present. He is on 20 mg Prednisone once daily and has recovered. He also has numbness in the right wrist.

He does not seem to have any other symptoms. Fever is not there since one week. He had a mild fever two weeks ago. There is no jaw pain or headache. What would you suggest to add clinically? Any exercises required?

Oral Atorvastatin was stopped last week. His Eosinophilia has been high for one year and Hb has always been low but no bowel issues.

Dr. Naval Mendiratta

Rheumatology
#

Hello,

Welcome back to icliniq.com.

Well, as of now the treatment line looks fine. We should taper and remove his steroids in three to four weeks time. Most patients of polymyalgia rheumatica do not need a second course of therapy. But there is a high chance of relapse as well. And in case it relapses, we will have to start with Methotrexate alongside.

Physical exercises, he can do whatever his body permits. Because of the inflammation, it may be difficult to do much but ask him to walk daily for 20-30 minutes. Secondly, for a while avoid any nonvegetarian food as that has shown to be a trigger for autoimmune disease as well.

I would suggest we taper and remove steroids over three to four weeks and repeat his blood test as well after a month. If inflammation is all settled we can remove the drugs and then just observe. Make sure calcium and vitamin D supplementation is being given alongside.

I hope this helps.


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