Laura, a 67-year-old woman

• Experiencing mild, aching discomfort in her shoulders for the last two months
  
• Shoulders are stiff upon awakening in the morning
  
• Stiffness lasts for about an hour
• Has difficulty moving shoulders although this improves throughout the day.

Further questioning reveals:

• Shoulder discomfort has come on gradually over the last four to six weeks
• Discomfort appears to be worse during the night and particularly in the morning when she gets up
• While discomfort not too bad during the day, there is some restriction of movement
• When sitting for a long period of time, there is some stiffness when she starts moving.

Recent developments:

• Felt an aching discomfort in hips, particularly the buttock area
• More noticeable when she gets up in the morning
• Also has some other but much less marked aches and pains in her shoulders and hip muscles
• Feels slightly unwell, tired and has lost 5 lbs in the last few months
• Has not experienced any feverish chills or night sweats
• Has been taking acetaminophen [TYLENOL*] for pain relief which has provided some help
• Otherwise well with no significant illnesses in the past; this is the first time she has felt so unwell.

  What should be included in the differential diagnosis? Check all that apply.

  	Inflammatory polyarthritis (e.g., rheumatoid arthritis)
  	Polymyalgia rheumatica
  	Fibromyalgia
  	Hypothyroidism
  	Carcinomatous neuromyopathy
  	(Submit)