S20_13

Polymyalgia rheumatica with normal erythrocyte sedimentation rate: Clinical aspects

V.M. Martínez-Taboada, R. Blanco, V. Rodríguez-Valverde

Service of Rheumatology, Hospital Universitario “Marqués de Valdecilla”, Facultad de Medicina, Universidad de Cantabria, Santander, Spain.

ABSTRACT
Polymyalgia rheumatica is a relatively common syndrome of the elderly characterized by severe pain and stiffness in the neck shoulder and pelvic girdles, along with increased acute phase reactants. The current diagnostic criteria include as a requirement an erythrocyte sedimentation rate (ESR) higher than 30 or 40 mm/1 hr.
Nevertheless, in several reports, a sizable proportion of patients with PMR, from 7% up to 22%, had an ESR that was either normal or slightly increased at the time of diagnosis, supporting the notion that an increased ESR should not be an absolute requirement for its diagnosis. This subset is characterized by a younger age, a less marked predominance of females, a longer diagnostic delay and a lower frequency of constitutional symptoms such as fever or weight loss. When determined, a majority of these patients had increased levels of C reactive protein.
The recognition of this subset of patients with PMR and a low ESR can be very useful to the clinician, avoiding unnecessary suffering of the patients and the risks of ineffective therapy with non-steroidal antiinflammatory drugs. To avoid the over-diagnosis of PMR in patients with a low ESR, we propose a set of criteria that can be easily applied in daily practice to patients with a clinical picture consistent with PMR but with a normal or slightly increased ESR.

Key words
Polymyalgia rheumatica, erythrocyte sedimentation rate, C reactive protein, diagnosis, diagnostic criteria.

This work was supported by a grant in aid from “Fundación Marqués de Valdecilla” 1998 and Fondo de Investigación Sanitaria (98/0846).

Please address correspondence and reprint requests to: Vicente Rodriguez-Valverde, M.D., Professor of Medicine and Chief, Rheumatology Service, Hospital Universitario “Marques de Valdecilla”, Av. Valdecilla s/n, 39008 Santander, Spain.
E-mail: rodriguv@medi.unican.es