Pitfalls in diagnosing geriatric general pain: coexistence of polymyalgia rheumatism and fibromyalgia.

Polymyalgia rheumatism and fibromyalgia are clinically similar. As there are no specific diagnostic markers, they are difficult to distinguish. A 92-year-old woman with a 3-month history of general pain, including left hip pain, was referred to our hospital. Her medical history included polymyalgia rheumatism that had been treated with prednisolone for 18 years. We found 14 of 18 symmetrical tender points. We diagnosed fibromyalgia based on two physical examinations and her personal history of general pain. Pregabalin was prescribed, and her pain gradually disappeared. About a month later, she complained of returned buttock pain and fever. She was diagnosed with exacerbation of polymyalgia rheumatism by various examinations and was treated with prednisolone. We found 3 of 18 asymmetrical tender points. No symptoms had recurred at the 1-month follow-up visit. Her case provides an opportunity to highlight the possible pitfalls when diagnosing geriatric general pain. © BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.