If a patient presents with stiffness in the shoulder and hip, what is the likely diagnosis?

• A. Osteoarthritis
• B. Polymyalgia rheumatica
• C. Rheumatoid arthritis
• D. Septic arthritis

Answer: (B)

The presentation of stiffness in the shoulder and hip in an older adult is highly suggestive of polymyalgia rheumatica. This condition is characterized by bilateral stiffness and pain in the shoulder girdle and pelvic girdle, often more pronounced in the morning or after periods of inactivity. Patients may also experience systemic symptoms such as fatigue, low-grade fever, and weight loss.

Polymyalgia rheumatica is closely associated with elevated inflammatory markers, such as erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), and is typically seen in individuals over the age of 50. The stiffness does not usually involve joint swelling, differentiating it from other forms of arthritis.

In contrast, osteoarthritis tends to cause joint pain and stiffness primarily associated with movement and is usually localized rather than systemic. Rheumatoid arthritis can present with joint stiffness but is more likely to involve the hands and is associated with synovial inflammation and damage to multiple joints over time. Septic arthritis presents with acute onset of joint pain, swelling, fever, and is typically localized to a single joint, often requiring immediate medical attention.

Therefore, the presence of shoulder and hip stiffness, particularly in an older adult, aligns with the features of polymy