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 January 2002, Practical Neurology strives to enhance quality of care and improve the daily operation of neurology practices. Each month, our experts explain the real-world significance of recent advances in neurologic science and offer step-by-step advice on how to overcome the clinical and business challenges neurologists face. Our straightforward, how-to articles give neurologists tools they can put into practice right away.