Polymyalgia rheumatica syndrome.

Eleven (14%( of 80 patients with polymyalgia rheumatica syndrome (PMR-S) recovered spontaneously within one year; two of them had received repeated injections of depot steroids before remission occurred. The remaining 69 patients, including 14 with giant cell arteritis (GCA), were all treated with systemic glucocorticoids for an average of 30 months (range 3-81 months). Nine of the patients developed side effects from the treatment, which in seven cases were severe osteoporosis and spinal compression. None suffered from loss of vision. The patients' mortality rate and causes of death did not differ from those of the population at large. The diagnostic criteria are discussed, with the omission of those applied for exclusion. Use of the common term PMR-S is preferred, as GCA and polymyalgia rheumatica (PMR) are clinically indistinguishable. Systemic glucocorticoids are urgently needed when arteritis or ocular manifestations are detected or even suspected. In uncomplicated cases of PMR we recommend that trials be made with repeated injections of depot steroids. This procedure could also be used in patients suffering from severe subjective recurrences after cessation of treatment with systemic glucocorticoids, thereby reducing the number of cases where steroid treatment is unquestionably maintained for too long.