Q9...DR.NADA A 25-year-old woman is evaluated during a follow-up visit for a 6-month history of diffuse muscle and joint pain above and below the waist, fatigue, and difficulty sleeping. She has a 2-year history of hypothyroidism treated with levothyroxine. Her only other medication is hydrocodone-acetaminophen, which has not relieved her pain. On physical examination, temperature is 37.0 °C (98.6 °F), blood pressure is 125/78 mm Hg, pulse rate is 85/min, and respiration rate is 12/min. Cardiopulmonary examination is normal. Musculoskeletal examination reveals diffuse periarticular tenderness, including bilateral tenderness in the biceps brachii, thighs, and calves. Muscle strength testing cannot be completed because of pain. The joints are not swollen, and she does not have lower-extremity edema. Laboratory studies: Complete blood count Normal Complete metabolic panel Normal Erythrocyte sedimentation rate 10 mm/h Creatine kinase 100 U/L Antinuclear antibodies Titer of 1:640 Thyroid-stimulating hormone 1.5 µU/mL (1.5 mU/L) Urinalysis Normal Which of following is the most likely diagnosis? A-Fibromyalgia B-Polymyositis C-Sjögren syndrome D-Systemic lupus erythematosus
Posted on: Tue, 19 Nov 2013 18:04:13 +0000
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