Unilateral polymyalgia rheumatica with controlateral sympathetic dystrophy syndrome. A case of asymmetrical involvement due to pre-existing peripheral palsy.

Another beneficial effect of statins may be the switch from Th1 to Th2 cytokines, as demonstrated for atorvastatine in a murine model [6]. Statins reduce CD40 expression in atheromaassociated cells in atherosclerotic lesions in situ in treated patients [7]. Fluvastatin has recently been shown to induce apoptosis in vitro in RA synoviocytes through a mitochondrial and caspase3-dependent pathway and by inhibition of the geranylgeranyl pathway [8]. One may speculate that some of these previously proven mechanisms of action may be of relevance in the presented case. Cholesterol crystalloids may appear as negatively birefringent, large, flat rectangular plates with notched corners, ranging from 8 to 100 m, consisting of monohydrate cholesterol. These are thermodynamically stable and not easily cleared. This case lends support to the hypothesis that locoregional monohydrate cholesterol production or one of the aforementioned mechanisms (suppression of class II MHC or Th1–Th2 switch) play a pivotal role in the aetiopathogenesis of cholesterol synovitis, as cholesterol synovitis can be inhibited by atorvastatine in humans.