Patient's Query
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 the 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 his eosinophilia has been 42 since before. Kindly suggest the diagnosis.
Kindly help.
Thank you.
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.
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.
I hope this helps.
Thank you.
Patient's Query
Hello doctor,
The pain is reduced. There is no specific stiffness, and my weight and appetite are fine. I have attached some blood reports. ESR - 72, CRP - 38. ANA is negative, and X-rays are not possible at present. He is on 20 mg of Prednisone once daily and has recovered. He also has numbness in the right wrist. He does not seem to have any other symptoms.
The fever has not been there for one week. He had a mild fever two weeks ago. There is no jaw pain or headache. What would you suggest adding clinically? Are 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.
Kindly help.
Thank you.
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. Most patients with 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 it.
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 to 30 minutes. Secondly, for a while, avoid any non-vegetarian food, as that is 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 the inflammation is all settled, we can remove the drugs and then just observe. Make sure calcium and vitamin D supplementation are being given alongside.
I hope this helps you.
Thank you.
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Answered byDr. Naval Mendiratta
Medically reviewed byDr. Vinodhini J.
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