- for PMR. Moreover, the distal pain in patient 1 and 1. Gonzalez-Gay MA, Garcia-Porrua C, Salvarani C, Olivieri I,
- the ineYcacy of corticosteroids in patient 2 raised the Hunder GG. The spectrum of conditions mimicking polymyal-
- suspicion of a diVerent disease. gia rheumatica in Northwestern Spain. J Rheumatol 2000;27:
- It has long been recognized that PMR-like 2179-84. 2. Cronin RE, Kachny WD, Miller PR, Stables DP, Gabow PA,
- symptoms may occur in patients with infections, Ostroy PR, et al. Renal cell carcinoma: unusual systemic
- neoplasms, or other rheumatic conditions (9). manifestations. Medicine 1976;55:291 -311.
- Paraneoplastic manifestations are present in up to 3. Sidhom OA, Basalaev M, Sigal LH. Renal cell carcinoma
- 20% of the patients with RCC (10-12). Among these, presenting as polymyalgia rheumatica. Arch Intern Med 1993;153:2043 -5.
- musculoskeletal manifestations resembling those of 4. Hopkinson N, Myint AA, Benjamin S. Polymyalgia and low
- PMR have been described in several reports (1,3-5). back pain: a common cause not to be missed. Ann Rheum
- A careful reading of the case descriptions shows Dis 1999;58:462 -4.
- that the clinical features are somewhat atypical to 5. Gonzalez-Gay MA, Garcia-Porrua C, Salvarani C, Olivieri I,
- those of pure PMR. As shown in Table I, all patients Hunder GG. Polymyalgia manifestations in diVerent conditions mimicking polymyalgia reumatica. Clin Exp Rheumatol
- presented atypical clinical features such as the distri-2000;18:755 -9.
- bution of pain, the absence of morning stiVness, 6. Salvarani C, Macchioni P, Boiardi L. Polymyalgia rheumatica.
- and of tenderness and limitation of motion of the Lancet 1997; 350: 43-7.
- shoulders. Moreover, the lack of response to corti-
- Hunder GG. Gian cell arteritis and polymyalgia rheumatica. In: Ruddy S, Harris ED, Sledge CB, editors. Kelleys Testbookcosteroids strongly suggested a diVerent diagnosis. of Rheumatology. 6th Edition. Philadelphia, WB SaundersIn addition, our report suggests another feature 2001:1155 -64.
- which may be useful for a correct diagnostic 8. Hazleman B. Polymyalgia rheumatica and giant cell arteritis.
- approach. Recently, magnetic resonance imaging and In: Klippel JH, Dieppe PA, editors. Rheumatology. 2nd Ed. London: Mosby; 1998:7.21.1 -8.
- ultrasonography studies evidenced that subacromial/ 9. Gonzalez-Gay MA, Garcia-Porrua C, Salvarani C, Hunder
- subdeltoid bursitis in association with joint synovitis GG. Diagnostic approach in a patient presenting with polymy-
- and biceps tenosynovitis represents the imaging algia rheumatica. Clin Exp Rheumatol 1999;17:276 -8.
- hallmark of PMR (13-15). 10. Gold PJ, Fefer A, Thompson JA. Paraneoplastic manifesta-
- There are no data on the articular imaging ? ndings
- tionsofrenalcellcarcinoma.SeminUrolOncol
- 1996;14:216 -22.of paraneoplastic PMR. However, in our patient 1 11. Papac RJ, Poo-Hwu WJ. Renal cell carcinoma: a paradigm of
- and 3, shoulder ultrasonography did not disclose any lanthanic disease. Am J Clin Oncol 1999;22:223 -31.
- synovial in? ammatory involvement. Therefore, the 12. Stummvold GR, Aringer M, Machold KP, Smolen JS,
- absence of articular and extraarticular synovitis may Raderer M. Cancer polyarthritis resembling RA as a ? rst sign of hidden neoplasms. Scand J Rheumatol 2001;30:40 -4.
- explain the diVerent clinical picture and physical 13. Salvarani C, Cantini F, Olivieri I, Barozzi L, Macchioni L,
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- assess the clinical and radiological diVerences between 14. Salvarani C, Cantini F, Olivieri I, Hunder GG. Polymyalgia reumatica: a disorder of extraarticular synovial structures?
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- elderly patient with proximal musculoskeletal pain 15. Cantini F, Salvarani C, Olivieri I, Niccoli L, Padula A,
- associated with elevated acute-phase reactants, the Macchioni L, et al. Shoulder ultrasonography in the diagnosis
- absence of morning stiVness, the atypical distribution of polymyalgia rheumatica: a case-control study. J Rheumatol 2001;28;1049 -55.
- of pain, the unresponsiveness to corticosteroids, and
Scandinavian Journal of Rheumatology
Volume 31, 2002 - Issue 2