Inability to Raise Extremities, Hard Skin in 50-year-old Woman

A 50-year -old woman with chronic renal failure and has been on hemodialysis for five years. She had multiple gadolinium enhanced MRIs for chronic low back pain (LBP). She developed inability to raise arms and legs that evolved over six months. She had no dysphagia. She was found to have hard skin and breasts and her CK level and EMG were normal.

The most likely diagnosis is:
1. Scleroderma
2. Polymyositis
3. Nephrogenic systemic sclerosis (NSS)
4. Polymyalgia rheumatica
5. Systemic calcinosis
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Launched in 2002, Practical Neurology is a publication uniquely dedicated to presenting current approaches to patient management, synthesis of emerging research and data, and analysis of industry news with a goal to facilitate practical application and improved clinical practice for all neurologists. Our straightforward articles give neurologists tools they can immediately put into practice.