Polymyositis vs. Polymyalgia Rheumatica

[Pox in a box]

Besides polymyositis having muscle weakness and polymyalgia rheumatica not generally having weakness, they seem to be very similar. How can you differentiate the two by history and physical? I've seen descriptions for both including "morning stiffness" with "difficulty rising from a chair or seated position."

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[deleted109597]

By seeing which diagnosis pays more under medicare billing.

Because seriously, neither of those diagnoses are truly important if they aren't fulminant, and PR is rarely fulmintant (when you consider that it is the latin for "multiple muscle pains of joints").

 

[Pox in a box]

By seeing which diagnosis pays more under medicare billing.

Because seriously, neither of those diagnoses are truly important if they aren't fulminant, and PR is rarely fulmintant (when you consider that it is the latin for "multiple muscle pains of joints").

I agree it's not a big deal in practice but I'm asking for Step 2. If it weren't an important distinction, I wouldn't ask.

 

[deleted109597]

Neither of them were on Step II for me.

 

[QuinnB]

Also PR is associated with temporal arteritis and PM is not...

 

[manning18]

The QBook explanations said Polymyositis would have an abnormal Neuro exam, while PR has a normal Neuro exam. PR is more of a vague disease and Dx of exclusion.

 

[manning18]

PR is more vague complaints of pain in the upper extremity, while Polymyositis is more muscle weakness, esp proximal muscles. Polymyositis should have more abnormal lab values (ie CK, ESR, Aldolase) than PR. First Aid explains each well.

 

[Pox in a box]

Neither of them were on Step II for me.

Then there's no way it will be on my exam. You must have seen all 368 of the questions they could have asked. Thanks everyone for the nuggets.

 

[manning18]

Pox: I don't think IbnSina meant to be sarcastic when he/she said Polymyositis and PR were not on his/her exam. Retaliating with sarcastic remarks often leads to threads of people exchanging insults that really benefit
noone. Hopefully, your initial question has been cleared up.

 

[mjl1717]

Neither of them were on Step II for me.

I think the most important thing is what is the incidence of these two diseases. Or could they be Hi Yield. I could tell you Osler Weber Rendu syndome was not on my exam.

 

[vagusbaby]

...

 

[Pox in a box]

Look at Pox's posting history - all taking, no giving and rude to boot. Perhaps that's why there are few replies to his post. No one likes being snapped at while trying to help.

Thanks new guy. I highly doubt you read through all the 1230+ posts I've made. You must have missed the contributions a lot of us Step 1 junkies had in the threads like the Step 1 Pimp Each Other Thread and the Step 1 advice I gave both on the forum and in PMs. Oh well, for what it's worth, if you take/took offense, I'm sorry. I try not to be as abrasive these days. I replied in a sarcastic manner because that post was just as sarcastic. Just because the topic doesn't appear on one's exam, doesn't mean that it isn't testworthy and isn't in the bank of questions that the board writers use.

 

[quinsy]

I took Step 2 yesterday and I had 3 questions for which I *believed* the answer was polymyalgia rheumatica. I'm not saying I was right every time, but it was one of the answers, so it's probably a good idea to be able to rule it out as a diagnosis.

I hope the UW questions didn't steer me wrong, because I based two of my answers on their question about the PR patient who presented with 'early' PR (and thus should be treated with steroids, I think). In both vignettes it made a point of saying that there was no proximal muscle weakness, which of course made me think I was probably wrong for putting PR as the answer... but polymyositis wasn't an option and I was stuck.

 

[tr]

PR is rarely fulminant (when you consider that it is the latin for "multiple muscle pains of joints").

Not to be obnoxious. Just informative. The terms are not Latin (they are Greek, as is 90% of medical terminology)

poly - multiple
my - muscle
algia - pain

but
rheum - flow

Rheumatic pain is so named not because of its location to the joints (the Greek root for 'joint' is arth, as in arthritis, arthralgia, arthroscopy, etc.). In medieval times 'rheumatic' pain was thought to be caused by the flowing of 'rheum' (illness-causing fluid). Hence rheumatic pain, rheumatic fever, rheumatism, etc. A rare case of a totally uninformative word root in medicine.

/pedantry

 

[deleted109597]

Not to be obnoxious. Just informative. The terms are not Latin (they are Greek, as is 90% of medical terminology)

poly - multiple
my - muscle
algia - pain

but
rheum - flow

Rheumatic pain is so named not because of its location to the joints (the Greek root for 'joint' is arth, as in arthritis, arthralgia, arthroscopy, etc.). In medieval times 'rheumatic' pain was thought to be caused by the flowing of 'rheum' (illness-causing fluid). Hence rheumatic pain, rheumatic fever, rheumatism, etc. A rare case of a totally uninformative word root in medicine.

/pedantry

Damn, I hate when I do that wrongly. Usually it's me that corrects people.
I'm reading Eats, Shoots, and Leaves right now. It is very witty.

Good call on the etymology though.

 

[Impressions]

Look at Pox's posting history - all taking, no giving and rude to boot. Perhaps that's why there are few replies to his post. No one likes being snapped at while trying to help.

Isn't it weird how someone that has supposedly given advice for first Step asks such easy and stupid questions on here for second Step.

 

[IK3]

This thread has been dead for a while and my only reason for this post for those who happen to be confused like I was and all you managed to read was some back and forth sarcasm. Anyway I was not sure how to differentiate the two since they can present very similarly. On UW what jumped out at me was CK that is elevated only in polymyositis, normal CK seen in PMR, also GCA can be associated with PMR. Everything else can go either way, so they both can have prox muscle weakness, elevated inflammatory markers, etc.

An obvious sign that it is polymyositis is anti-Jo antibodies, but they don't usually give you that when they expect you to differentiate.