A clinical case of polymyalgia rheumatica in a patient with postmenopausal osteoporosis

Abstract

Polymyalgia rheumatica (PMR) is a chronic disease affecting the musculoskeletal system in patients over 50 years of age and is characterized by bilateral restriction of movement in the shoulder and hip joints, as well as prolonged morning stiffness. This disease is characterized by an increase in the erythrocyte sedimentation rate and the concentration of C-reactive protein in the blood. A clinical case of PMR in a 67-year-old patient with postmenopausal osteoporosis, which complicates treatment with glucocorticoids, is described. In addition to the mandatory diagnostic criteria, additional signs were identified, the total of which amounted to 6 points: morning stiffness lasting more than 45 minutes (2 points), pain in the hip joints and limited mobility of those joints (1 point), absence of an increase in the level of rheumatoid factor in the blood serum (2 points), and the presence of ultrasound signs of synovitis and tenosynovitis of the long head of the biceps muscle in both shoulder joints (1 point). A positive trend in clinical condition and laboratory parameters was observed during the treatment of PMR with methylprednisolone. The monitored parameters of bone mineral density of the spine and femoral neck indicated that continuation of denosumab therapy for the prevention of recurrent fractures, initiated even before the diagnosis of PMR due to concomitant postmenopausal osteoporosis, was advisable during glucocorticoid administration.