An inflammatory clinical syndrome characterized by pain and morning stiffness of the shoulder, hip girdles, and neck; primarily impacts patients over the age of 50. Associated with m...
Suspect PMR in elderly patients with new onset of proximal limb pain and stiffness (neck, shoulder, hip). Patients may use the term stiffness and pain interchangeably (2). Shoulder p...
Address risk of steroid-induced osteoporosis.
Obtain dual energy x-ray absorptiometry and check 25-OH vitamin D levels if necessary.
Consider antiresorptive therapies (bisphosp...
Monthly evaluations initially and during medication taper; every 3 months otherwise
Follow ESR as steroids are tapered; ESR and C-reactive protei...
Figus FA, Skoczyńska M, McConnell R, Massazza G, Iagnocco A. Imaging in polymyalgia rheumatica: which technique to use? Clin Exp Rheumatol. 2021;39(4):883-888.
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M35.3 Polymyalgia rheumatica
M31.5 Giant cell arteritis with polymyalgia rheumatica
65323003 Polymyalgia rheumatica (disorder)
239938009 Giant cell arteritis with polymyalgia rheumatica ...
Consider PMR in patients >50 years who present with hip, neck, and/or shoulder pain and stiffness.
A normal ESR does not exclude PMR.
Corticosteroids are the treatment of choice. If t...
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FIGURE 26.4. Gross appearance of chronic interstitial pneumonia in rheumatoid arthritis. Zones of honeycombing can be seen in the posterior subpleural regions. Some contraction and thickening of the lung also are noted, along with pleural thickening.
FIGURE 26.4. Gross appearance of chronic interstitial pneumonia in rheumatoid arthritis. Zones of honeycombing can be seen in the posterio...
Radiographs of the MCP joints of a patient with rheumatoid arthritis demonstrate loss of joint space and some overlap of the metacarpal head on the proximal phalanx, indicating early palmar subluxation of the proximal phalanx. These findings are usually seen in a progressive fashion, with the radial side being worse.
Radiographs of the MCP joints of a patient with rheumatoid arthritis demonstrate loss of joint space and some overlap of the metacarpal he...
Swan-neck deformity of the index finger in a patient with rheumatoid arthritis. Hyperextension of the proximal interphalangeal (PIP) joint and flexion deformities of the metacarpophalangeal (MCP) and distal interphalangeal (DIP) joints.
Swan-neck deformity of the index finger in a patient with rheumatoid arthritis. Hyperextension of the proximal interphalangeal (PIP) joint...
A: A 55-year-old female with a type III deformity secondary to rheumatoid arthritis.
<bold>FIG. 108.1.</bold> Degenerative joint disease of the knee. Large areas of erosion of articular cartilage are present on the patellar facet and on the condyles of the femur. These erosions occupy principally the central portions of the joint surfaces and spare the marginal regions. The cartilage at the eroded edges is fi illated. The irregular elevations at the periphery of the surfaces are osteophytes.
<bold>FIG. 108.1.</bold> Degenerative joint disease of the knee. Large areas of erosion of articular cartilage are present on ...
<bold>FIG. 108.8.</bold> Heberden node. The articular cartilage has completely disappeared from the surfaces of the distal interphalangeal joint. Bony osteophytes, directed toward the base of the finger, are present on the dorsal and palmar aspects of both articulating surfaces. Advanced osteoarthritic changes also are present in the proximal interphalangeal joint and form a so-called Bouchard node. (Hematoxylin and eosin stain, original magnification 320.)
<bold>FIG. 108.8.</bold> Heberden node. The articular cartilage has completely disappeared from the surfaces of the distal int...
<bold>FIG. 65.9.</bold> "Whittling" of the middle phalanx and expansion of the base of the distal phalanx—the "pencil-in-cup" deformity.
<bold>FIG. 65.9.</bold> "Whittling" of the middle phalanx and expansion of the base of the distal phalanx—the "pencil-in-cup" ...
<bold>FIG. 65.12.</bold> Destructive arthritis of an isolated distal interphalangeal joint with osteolysis of the proximal phalanx.
<bold>FIG. 65.12.</bold> Destructive arthritis of an isolated distal interphalangeal joint with osteolysis of the proximal pha...
<bold>FIG. 65.14.</bold> Prominent metatarsophalangeal joint involvement with subluxation and cupping of the base of the proximal phalanges. The big toe distal interphalangeal joint shows characteristic marginal erosions.
<bold>FIG. 65.14.</bold> Prominent metatarsophalangeal joint involvement with subluxation and cupping of the base of the proxi...
<bold>FIG. 75.3.</bold> Histopathology of inflammatory myopathies. A,B: Muscle biopsies from polymyositis patients tend to show focal endomysial infiltration by mononuclear cells (A: hematoxylin and eosin stain), while those from dermatomyositis patients show more perivascular and interstitial inflammation with perifascicular myofiber atrophy (B: modified trichrome stain). C: Transverse fresh-frozen section of muscle from a patient with inclusion body myositis displaying purplish granular materia...
<bold>FIG. 75.3.</bold> Histopathology of inflammatory myopathies. A,B: Muscle biopsies from polymyositis patients tend to sho...
Rheumatoid arthritis. (A) The hyperplastic synovium from a patient with rheumatoid arthritis shows numerous finger-like projections, with focal pale areas of fibrin deposition. The brownish color of the synovium reflects hemosiderin accumulation derived from old hemorrhage. (B) A microscopic view reveals prominent lymphoid follicles (Allison - Ghormley bodies), synovial hyperplasia and hypertrophy, villous folds, and thickening of the synovial membrane by fibrosis and inflammation. (C) A hi...
Rheumatoid arthritis. (A) The hyperplastic synovium from a patient with rheumatoid arthritis shows numerous finger-like projections, with ...
Rheumatoid nodule. (A) A patient with rheumatoid arthritis has a mass on a digit. (B) A microscopic view of a rheumatoid nodule shows a central area of necrosis surrounded by palisaded macrophages and a chronic inflammatory infiltrate.
Rheumatoid nodule. (A) A patient with rheumatoid arthritis has a mass on a digit. (B) A microscopic view of a rheumatoid nodule shows a ce...
FIGURE 50.4 Rheumatoid arthritis. (A) Early. (B) Advanced.
FIGURE 19-11.?Advanced rheumatoid arthritis. The hands show swelling of the joints and deviation of the fingers.
Osteoarthritis
Figure 10-5 <bold>INFLAMMATORY VERSUS DEGENERATIVE ARTHRITIS.A. Inflammatory Arthritis (Rheumatoid Arthritis).</bold> The most prominent feature is the uniform bicompartmental loss of joint space.<bold> B. Degenerative Arthritis (Degenerative Joint Disease).</bold> In contrast, selective loss of a single compartment joint space in a non-uniform manner is apparent.<bold><italic>COMMENT:</bold></bold> This is an important differential feature between inflammatory and degenerative joint changes.
Figure 10-5 <bold>INFLAMMATORY VERSUS DEGENERATIVE ARTHRITIS.A. Inflammatory Arthritis (Rheumatoid Arthritis).</bold> The most...
Figure 10-46 <bold>DEGENERATIVE JOINT DISEASE: KNEE. A. Recumbent. B. Erect.</bold> Observe the loss of lateral joint space not seen on the recumbent film (<italic>arrow</bold>).
Figure 10-46 <bold>DEGENERATIVE JOINT DISEASE: KNEE. A. Recumbent. B. Erect.</bold> Observe the loss of lateral joint space no...
<bold><italic>Figure 10.27.</bold></bold> Degenerative joint disease of fingers: Bouchard's nodes on proximal interphalangeal (PIP) joint, Heberden's nodes on distal interphalangeal (DIP) joint. Look for the company of other finger or of thumb osteoarthritis.
<bold><italic>Figure 10.27.</bold></bold> Degenerative joint disease of fingers: Bouchard's nodes on proximal inte...
Left Hand and Wrist with Osteoarthritis Unlabeled