Differential Diagnosis of Polymyalgia Rheumatica
What other diagnoses should be considered prior to diagnosing Polymyalgia Rheumatica? How are they differentiated?
The below table lists factors to consider in the differential diagnosis of PMR.
Differential Diagnosis List in Polymyalgia Rheumatica/Giant Cell Arteritis
| Diagnosis | Distinguishing Features |
|---|---|
| Chronic pain syndrome (i.e., fibromyalgia, etc) | Tender points, normal ESR |
| Hypothyroidism | Elevated thyroid-stimulating hormone |
| Depression | Normal ESR |
| Polymyositis | Proximal muscle weakness without pain; elevated creatine kinase; abnormal electromyography |
| Malignancy (especially lymphoma, myeloma) | Clinical evidence of neoplasm (except for possible myelodysplastic syndromes, there is no association of cancer with PMR) |
| Occult infection (TB, HIV, SBE) | Clinical suspicion of infection; cultures and serologies |
| Late-onset spondyloarthropathy | Low back pain, psoriasis, a reactive arthritis-related infection, abnormal sacroiliac radiographs |
| Rheumatoid arthritis | |
| Shoulder osteoarthritis, rotator cuff, frozen shoulder | Physical exam, shoulder radiographs, normal ESR |
ESR, Erythrocyte sedimentation rate; HIV, human immunodeficiency virus; PMR, polymyalgia rheumatic; SBE, subacute bacterial endocarditis; TB, tuberculosis.
