Management of polymyalgia rheumatica in the primary health care setting: a comprehensive care report

Introduction: Polymyalgia Rheumatica (PMR) is a systemic inflammatory rheumatic disease of the adult, characterized by pain, morning stiffness, and a negative impact on daily activities. Objective: To provide a comprehensive description of a clinical case of PMR in a complex patient within the Primary Health Care (PHC) setting. Methods: This report follows the CARE guidelines, and appropriate patient consent was obtained. A 63-year-old male with multimorbidity presented with a two-week history of left hip pain. Two weeks later, and following two unsuccessful pharmacological treatments, he developed difficulty mobilizing the glenohumeral joints, along with morning stiffness in the shoulder and pelvic girdles lasting at least 30 minutes. Based on suggestive laboratory findings, a diagnosis of PMR was confirmed, and appropriate corticosteroid therapy was initiated. Results: The initial symptoms represented an atypical presentation of PMR, leading to a delayed diagnosis. Adjustments to Diabetes Mellitus medication were required, as well as the implementation of prophylactic measures for corticosteroid-induced osteoporosis. Conclusion: This case underscores the importance of considering PMR in the differential diagnosis of joint pain in the PHC setting. It demonstrates the essential role of the open-door policy characteristic of PHC in addressing non-specific pain complaints and highlights the Family Physician's expertise in managing patients with multimorbidity, including pain management.