29th April 2024

A 68-year-old woman presents with a 3-month history of severe pain and stiffness in her shoulders and hips, most pronounced in the mornings and improving slightly with activity.

A 68-year-old woman presents with a 3-month history of severe pain and stiffness in her shoulders and hips, most pronounced in the mornings and improving slightly with activity. She also reports generalised fatigue, a mild fever, and a recent unintentional weight loss. She denies any history of joint swelling or redness. On examination, there is significant pain on passive movement of her shoulders and hips, but no obvious joint swelling.

Investigations:

Erythrocyte sedimentation rate (ESR): Elevated

C-reactive protein (CRP): Elevated

Rheumatoid factor: Negative

Normal thyroid function tests

No abnormalities on X-ray of shoulders and hips

Which is the most likely diagnosis?