Polymyalgia rheumatica and giant cell arteritis--a difficult diagnosis

This five-year study of 108 patients with giant cell arteritis and/or polymyalgia rheumatica drawn from all departments of a district general hospital emphasizes the difficulties of diagnosis. A correct diagnosis was made by the referring doctor in 33 per cent of patients and on initial attendance at hospital in 67 per cent of patients. Symptoms were present for more than three months before referral to hospital in 39 per cent of patients, and the delay before diagnosis at hospital was greater than one month in 20 per cent. Systemic illness (present in 83 per cent of cases), anaemia (33 per cent), elevated alkaline phosphatase (73 per cent) and raised immunoglobulin levels (48 per cent) caused diagnostic problems in 28 patients at primary care level and in 23 patients at hospital.