Hip pain differential diagnosis polymysitis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Polymyositis is a systemic connective tissue disorder characterized by inflammatory effects in the muscles and skin, leading to symmetric weakness and some degree of muscle atrophy.

The areas principally affected are the hip, shoulders, arms, throat and neck. Muscle pain and swelling, as well as weakness of neck and limb muscles occur. Skin rash typically affects the cheeks, eyelids, neck, chest, and limbs. Muscle abnormalities start with aches and weakness of the muscles of the trunk, upper arms, hips, and thighs. Muscles may be stiff, sore, and tender and, eventually, show signs of atrophy.

Blood tests show that the creatinine phosphokinase (CPK) level is elevated. Serum creatinine is also elevated, as is serum aldolase. An electromyogram shows muscle irritability in association with characteristic myopathic units. A muscle biopsy can confirm the diagnosis.

Polymyositis is sometimes associated with malignancy.

Polymyositis rarely causes isolated hip pain.

Other causes of hip pain should be considered in the differential diagnosis of hip pain in patients with polymyositis. In the older patient, osteoarthritis may cause hip pain. Low back disorders may cause referred pain to the hip. Avascular necrosis as a result of steroid therapy is another cause of hip pain. As with other situations, tendonitis and bursitis may occur.

Effective treatment of polymyositis consists of immunosuppressive agents. The first-line agent is prednisone. Prednisone may be started in high oral doses for 3-4 weeks until a favorable response is obtained. The drug results in an improvement of symptoms and a decrease in CPK levels. Prednisone is then slowly tapered until an every other day regimen can be instituted. If steroids are ineffective, other immunosuppresants are used.

In an article published in Rheumatology (Rheumatology 2000; 39: 211-213) a discussion of a rare type of polymyositis associated with hip pain was reported.

Idiopathic focal myositis in pregnancy

A. Hepburn, N. Damani, A. Sandison and N. Pandit

Department of Rheumatology, Department of Radiology, Watford General Hospital, Watford, Hertfordshire WD1 8HB and Department of Histopathology, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK

Focal myositis is a rare, benign inflammatory disorder of skeletal muscle, the cause of which is unknown. It usually affects limb musculature, although rarely muscles of the head and neck and spine can be involved. The development of the more common generalized inflammatory myopathies, polymyositis and dermatomyositis, has been reported in pregnancy. The subsequent clinical course in these disorders is variable. A case of idiopathic focal myositis affecting the abductors of the thigh developing acutely in a young woman during pregnancy, with subsequent spontaneous remission.

Polymyositis may begin as a localized lesion. Polymyositis and dermatomyositis developing during pregnancy are associated with a variable outcome. Evidence suggests an adverse outcome in terms of prematurity, abortion and perinatal death.

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