We report a case of an 82-year-old woman with
polymyalgia rheumatica (PMR) associated with swelling and pitting
edema of the lower extremities. The patient had been previously admitted because of PMR in 1990, but there was no history of swollen extremities. In July 1996, at another hospital, she was again diagnosed as having PMR on the basis of
pain in the neck, shoulders and lower back. Administration of
prednisolone was followed by improvement of the symptoms. Four months later, similar
pain recurred and swelling of the lower extremities was noted. On admission, the erythrocyte sedimentation rate was 86 mm/h, and
C-reactive protein was 15.5 mg/dl. Reviewing the previous treatment, it was ascertained that her
clinical deterioration was due to premature reduction of the
steroid dosage. The cause of the swelling of the lower extremities was unlikely to be heart, liver, kidney or
endocrine disease.
Prednisolone was increased from 2.5 mg to 10 mg daily with marked improvement in all the symptoms including the swelling and pitting
edema. In 1996, a study reported distal extremity swelling with pitting
edema as a manifestation of PMR, which mostly developed concurrently with proximal symptoms or during relapses of PMR. The swelling responded poorly to non-steroidal antiinflammatory drugs but promptly to
corticosteroids. The distal swelling was reported to be
tenosynovitis and
synovitis of the surrounding structures. The present case appears similar to that report. More studies of PMR need to be done.