41. An advanced practice registered nurse (APRN) is assessing a patient who presents to the clinic with aching and stiffness of the neck, shoulder, and pelvic girdle. The patient complains that the stiffness typically lasts all morning. The patient's ESR and C-reactive protein are both elevated. Which condition should the APRN suspect?
Answer: D
Polymyalgia rheumatica should be suspected by the APRN.
The patient's symptoms of aching and stiffness in the neck, shoulder, and pelvic girdle, along with morning stiffness and elevated ESR and C-reactive protein, strongly indicate polymyalgia rheumatica.
A) Osteoarthritis
Osteoarthritis is characterized by joint pain and stiffness, typically worsened with activity and improved with rest, rather than being predominantly morning stiffness. The elevated inflammatory markers (ESR and C-reactive protein) are not typically associated with osteoarthritis, making this option incorrect.
B) Lupus
While lupus can cause joint pain and elevated inflammatory markers, it usually presents with a variety of systemic symptoms such as rash, photosensitivity, and organ involvement. The specific pattern of morning stiffness in the neck, shoulder, and pelvic girdle is more indicative of polymyalgia rheumatica rather than lupus.
C) Raynaud phenomenon
Raynaud phenomenon primarily affects blood flow to the extremities during cold or stress, leading to color changes and pain in fingers and toes. It does not typically cause widespread musculoskeletal symptoms such as those presented by the patient, making this option irrelevant.
D) Polymyalgia rheumatica
Polymyalgia rheumatica is characterized by bilateral shoulder and hip girdle pain and stiffness, particularly in the morning, and is associated with elevated ESR and C-reactive protein. These symptoms align perfectly with the patient’s presentation, confirming this as the most likely diagnosis.
Conclusion
Polymyalgia rheumatica is the most fitting diagnosis given the patient’s specific symptoms of morning stiffness and elevated inflammatory markers. Other options, such as osteoarthritis, lupus, and Raynaud phenomenon, do not align as closely with the clinical picture, thus reinforcing that polymyalgia rheumatica is the most plausible condition the APRN should suspect.