Polymyalgia Rheumatica During the Course of Limited Cutaneous Scleroderma: An Unusual and Challenging Coexistence.

Abstract

A 50-year-old patient with a history of limited cutaneous scleroderma began with polyarthralgia (left shoulder, elbows and hips) without stiffness or associated inflammatory syndrome. Treatment with oral anti-inflammatory drugs was started on suspicion of peripheral spondyloarthritis with partial response. This progressed with the appearance of stiffness and functional limitation of the hips as well as an increase in the inflammatory syndrome two weeks after onset. It was decided to perform an ¹⁸F-FDG-PET scan compatible with polymyalgia rheumatica. The patient was treated with oral corticosteroids with an excellent response after one week of treatment.

Learning points: Polymyalgia rheumatica should be considered, even in young adults, with atypical clinical presentation.Post-infectious and paraneoplastic inflammatory rheumatism should be ruled out before considering the diagnosis of polymyalgia rheumatica.¹⁸F-FDG-PET plays an important role in the positive diagnosis of PMR and in the differential diagnosis.