Temporal arteritis after normalization of erythrocyte sedimentation rate in polymyalgia rheumatica

We describe a 72-year-old woman with classic presentation of polymyalgia rheumatica and an elevated erythrocyte sedimentation rate. After treatment with low-dose corticosteroids and normalization of the sedimentation rate, hematocrit, and serum alkaline phosphatase, she developed symptoms and biopsy proved temporal arteritis. In patients with polymyalgia rheumatica and an initially elevated sedimentation rate, normalization of the sedimentation rate with corticosteroid therapy does not exclude the need for temporal artery biopsy if the symptoms warrant it.