Clinical features of polymyalgia rheumatica

• pain and stiffness in proximal muscles of shoulder and pelvic girdle, cervical spine (Fig 28.7)

o symmetrical distribution o typical ages 60-70 years (rare < 50)

o both sexes: more common in women o early morning stiffness o may be systemic symptoms: weight loss, malaise, anorexia o painful restriction of movement of shoulders and hips o signs may be absent later in day

Fig. 28.7 Polymyalgia rheumatica: typical sites of areas of pain and stiffness

Constipation Prescription

Constipation Prescription

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