Symptoms of symmetrical stiffness in an older patient with high ESR might suggest which condition?

Symptoms of symmetrical stiffness in an older patient, particularly when accompanied by a high erythrocyte sedimentation rate (ESR), suggest the possibility of polymyalgia rheumatica. This condition is characterized by muscle pain and stiffness, particularly in the shoulder and hip regions. The symmetrical nature of the symptoms along with the elevated ESR makes polymyalgia rheumatica a strong contender, as it is an inflammatory condition that commonly affects older adults and leads to marked increases in inflammatory markers.

Polymyalgia rheumatica is often seen in patients over the age of 50 and can be associated with giant cell arteritis, further supporting its relevance in this demographic. The stiffness typically worsens in the morning or after periods of inactivity and improves with movement, which aligns with the patient's presentation.

In contrast, while rheumatoid arthritis can also present with symmetrical stiffness and elevated ESR, it is more commonly marked by joint swelling and deformities, and its onset pattern can differ. Gout typically presents with acute episodes of pain and inflammation rather than generalized stiffness. Systemic lupus erythematosus might present with joint symptoms too, but it usually includes a broader range of systemic symptoms and is more common in younger women. Therefore, polymyalgia rheumatica