Abstract
Polymyalgia rheumatica (PMR) is a common disease in the elderly population. The diagnosis is based upon recognition of clinical symptoms, consisting of pain and stiffness in the shoulder and pelvic girdle, muscle tenderness of the upper and lower limbs and nonspecific somatic complaints. We are presenting two patients with PMR and severe dementia, who were not able to complain their symptoms. Patient1; an 84-year-old woman was referred to us for the bilateral swelling of hands and feet. She did not complain of any symptoms, however, her activities of daily living (ADL) had gradually decreased. A diagnosis of PMR was made by elevated ESR/CRP and the findings observed by nursery-home staff members. Treatment with 10 mg/day of prednisolone (PSL) was started with a dramatic response. Patient 2; an 80-year-old woman had repeated intermittent fever for six months. She was referred to us because her son wanted to know the cause of her fever. She did not complain of any pain and was not able to answer any questions. A diagnosis of PMR was made and PSL was started at 10 mg/day after the investigations of malignancy. In both patients, the observations by nursery-home staff members and family members were insufficient, but very important. Comprehensive geriatric assessment (GCA) is, which is a multidisciplinary evaluation for older people who have multiple problems, should be given greater emphasis, as a screening and follow-up tool.
