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Case study – Pam

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This case study is an example of the type of case you might see in general practice. Use it alongside the general course information to help guide you through the process of assessing a patient whose symptoms could suggest a diagnosis of PMR. 

Pam, a 67-year-old retired schoolteacher, visits you because she's been troubled by a flare-up of her 'arthritis' for the past four weeks. Her hips and shoulders are particularly affected. She has consulted only infrequently in the past and considers herself to be in good health generally.

She experienced some flu-like symptoms about 3–4 weeks ago, closely followed by the pain and stiffness which have worsened rapidly over the last week.

Direct questioning reveals:

  • severe stiffness in the morning, particularly for the first hour or so – she's unable to turn over or sit up in bed without help from her husband, and it takes a couple of hours for her to get going
  • lethargy – she feels 'completely drained'
  • a bit low in mood
  • no headaches or visual disturbance
  • a family history of osteoarthritis.

Pam's history

  • osteoarthritis of hips and knees
  • 1995 gastric ulcer – treated medically
  • 2007 breast cancer – treated with mastectomy and adjuvant chemotherapy
  • Medication:
    • tamoxifen 20mg od
    • co-dydramol 10/500 2 QDS prn
    • omeprazole 20mg od prn
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