Differential Diagnosis of Polymyalgia Rheumatica

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

DiagnosisDistinguishing Features
Chronic pain syndrome (i.e., fibromyalgia, etc)Tender points, normal ESR
HypothyroidismElevated thyroid-stimulating hormone
DepressionNormal ESR
PolymyositisProximal 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 spondyloarthropathyLow back pain, psoriasis, a reactive arthritis-related infection, abnormal sacroiliac radiographs
Rheumatoid arthritis
Shoulder osteoarthritis, rotator cuff, frozen shoulderPhysical exam, shoulder radiographs, normal ESR

ESR, Erythrocyte sedimentation rate; HIV, human immunodeficiency virus; PMR, polymyalgia rheumatic; SBE, subacute bacterial endocarditis; TB, tuberculosis.

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