Variability of Steroid Response Time in Polymyalgia Rheumatica: A Case Report

Abstract

We present a unique case of a 75-year-old Caucasian female who presented with a two-month history of unrelenting proximal muscle pain and stiffness in the neck, shoulders, and pelvic girdle that lasted for 45 minutes each morning upon waking. Due to clinical suspicion of polymyalgia rheumatica (PMR), the patient was started on the standard therapy of low-dose glucocorticoid therapy and was noted to have a dramatic improvement in terms of pain, strength, mobility, and range of motion. Current literature shows high variability in the standard response time to treatment. Typical resolution of symptoms occurs within a span of one day to months. The case presented in our study shows symptom resolution as well as marked improvement in muscle strength and mobility within 12 hours. The purpose of this case report is to provide additional information for physicians when considering symptom-resolution time related to low-dose glucocorticoid therapy and PMR. Additionally, we briefly explore the literature on the correlation between giant cell arteritis (GCA) and glucocorticoid therapy for PMR as well as the data associated with adjuvant therapy using immunomodulatory treatment.

Keywords: inflammatory arthritis; low dose corticosteroids; muscle pain; pelvic girdle; polymyalgia rheumatica; shoulders.

Figure 1. Radiologic imaging

A) CT of the head revealed chronic findings without any acute intracranial abnormalities or neurovascular changes; B) X-ray of the right shoulder showed degenerative changes associated with mild osteoarthritis