Case Study

Joan is a 64 yr old retired school teacher who presents with a rapidly progressing story of pain and stiffness in her shoulders and thighs. She feels terrible, with poor sleep due to pain. Walking up stairs is painful. She is having trouble sleeping. She has a headache centred on the back of her neck. There is no significant past history of arthritis. She has hypertension and hyperlipidaemia and is taking an ACE inhibitor and Simvastatin. Her vision is normal. She has had no rash and has not been overseas lately.

 

On examination you find that she is afebrile, her joints normal but she is tender to touch over the deltoids and quads.

 

She is distressed by the level of pain and is crying during the consultation.

 

Consider the possible diagnoses for Joan.