A Patient Suffering From Pain and Malaise

Robert M. Centor, MD

Disclosures

March 14, 2006

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Case Presentation

JB is a 60-year-old man who comes in with complaints of pain. He currently has pain in his hands, shoulders, and hips. He first noticed the pain in his hands 2 months ago. He worked as a construction worker, and was no longer able to carry concrete blocks. Over the next month his pain spread from his hands to his hips and shoulders.

The patient has lost 13 pounds over 2 months. He had several NSAID trials (from other physicians) without relief. He complains of general malaise and great frustration.

The pain is worse in the morning, improving slightly during the day.

His hand pain is accompanied by swelling and stiffness.

His shoulder pain prevents him from touching his head.

His hip pain leads to a painful, slow gait.

On physical exam, he is entirely normal except for the musculoskeletal exam. His hand exam reveals symmetrical tender and spongy PIP and MCP joints of all fingers. His shoulders are tender. He is unable to resist motion of shoulders in any direction. His arm muscles are normal, with normal strength. The muscles are not tender. He is unable to resist hip motion, but again, his leg musculature is intact.

The Problem

What is the likely diagnosis?

What diagnostic tests would you order?

Would you treat him at this time?

Discussion

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Comments

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