Polymyalgia rheumatica and temporal arteritis.

There is a fairly common form of rheumatism which afflicts the elderly with pains in the head, neck, back, and proximal parts of the limbs, with stiffness of movement and with constitutional illness. It is associated with a raised sedimentation rate (E.S.R.) and a mild hypergammaglobulinaemia, and women are affected more frequently than men. There is as yet no specific test for this condition, but the rapid response to corticosteroid therapy, combined with the negative results from investigations to detect other diseases, provide a reproducible diagnostic situation which has been called "polymyalgia rheumatica" (Barber, 1957). Two schools of thought exist. One regards polymyalgia rheumatica as a variant or prodromal phase of temporal arteritis. The other regards it as an entity in its own right linked, perhaps, to rheumatoid arthritis (Kersley, 1951) and various suitable names have been proposed, e.g. "anarthritic rheumatoid disease" (Bagratuni, 1953, 1956) or "pseudospondylite rhizomelique" (Forestier and Certonciny, 1953). Gordon, Rennie, and Branwood (1964) presented biopsy studies on six cases of polymyalgia rheumatica showing evidence of low-grade chronic inflammatory changes around the shoulder joint and the fibrous supporting tissues of the shoulder girdle. Other students of polymyalgia rheumatica have not found clinical signs of temporal arteritis (Barber, 1957; Gordon, 1960; Boyle and Beatty, 1961; Chalmers, Alexander, and Duthie, 1964; Tweed, 1965; Andrews, 1965), but temporal arterial biopsies were not done routinely in their series. Those authors who have linked polymyalgia rheumatica to temporal arteritis, also called cranial