Polymyalgia rheumatica and giant cell arteritis: a seven-year survey

The seven-year results of all cases (84) diagnosed as polymyalgia rheumatica or giant cell arteritis are reported. The diagnosis proved to be incorrect in seven, of which six had a polyarthritis. Most cases were treated with prednisolone, starting with 20 mg daily for those with evidence of cranial arteritis, and 10 mg for those without. Fourteen patients were withdrawn from treatment (after three months to 31/2 years--mean 21 months), but three relapsed and treatment has been restarted. There was no correlation between the presence or absence of arteritis, the starting dose of prednisolone and the subsequent duration of treatment. A small group (7) received higher doses without obvious advantage. Twenty-two started on 5-9 mg daily, but the dose had to be increased in 13 because of inadequate control of symptoms. Objective physical abnormality, particularly painful limitation of shoulder movement, was present in most cases. No patient developed a serious complication of the disease after treatment had been started. Complications of treatment were infrequent. Spinal osteoporosis occurred in seven, but did not cause long-term disability.