POLYMYALGIA RHEUMATICA: A NOT SO BENIGN SYNDROME

A prospective study of 11 cases of polymyalgia rheumatica is presented. The average age of the eight women and three men in the study was 75 years. Polymyalgia rheumatica as a primary diagnosis was often overlooked, but in fact the history is a most significant feature of the illness. Clinically it is often not possible to distinguish between polymyalgia rheumatica, temporal arteritis and giant cell arteritis, and there is evidence that these three disorders represent a spectrum of a single disease process. Ancillary diagnostic aids are a high ESR and disturbances of the globulin serum protein fraction on electrophoresis, with a normochromic normocytic anæmia, and occasionally a positive temporal artery biopsy. Steroid therapy has become the treatment of choice. An alternate‐day single‐dose regimen has proved satisfactory. Of the 11 patients, one developed evidence of polyarteritis nodosa, and later Sjögren's syndrome, and finally lymphosarcoma. A second patient, after a complete remission of nine months, relapsed and, despite increasing steroid dosage, died of cerebral causes. A third patient developed severe congestive cardiac failure and atrial fibrillation, but these complications have since completely remitted. Polymyalgia rheumatica in this series has been a disorder whose benign nature has been called in question.