Cold Shoulder

A 64 year old women presents with pain and stiffness in both shoulder girdles for 3 months.

These symptoms are present upon waking up, and last for a couple of hours before gradually subsiding. She noticed that the stiffness tends to decrease with gentle activity, and is increased by prolonged rest.

She also complains of gradual loss of weight during this time, and of constantly feeling fatigued.

Her medical history is unremarkable, and she is not on any drugs. X-rays of both shoulders appear to be normal.

Select Relevant Investigations
ESR + CRP

Performed

ESR: 82 mm/1h (<20)
CRP: 15 mg/dL (0-1.0 mg/dL)
CPK

Performed

Serum CPK: 70 U/L (22-198)
Full Blood Count

Performed

WBC/DC: 8,000/mm3 (4,500-11,000)
Hb: 14.0 g/dL (11 - 18)
Platelets: 380,000/mm3 (150,000 - 400,000)
Autoantibody Screen

Performed

ANA: negative
ds-DNA: negative
Rheumatoid Factor: negative
Anti-CPA: negative

Select Relevant Management
Corticosteroids
Analgesics
Anti-TNF agents
Vitamin D & Calcium