Malignancy in Association with Polymyalgia Rheumatica and Temporal Arteritis

In a series of 45 patients with polymyalgia rheumatica (PMR) and/or temporal arteritis (TA), the clinical course in four of six fatal cases was associated with malignancy. In one case the poiymyalgic symptoms were clearly associated with the recurrence of a previously operated uterine carcinoma. This case represented a paraneoplastic phenomenon and responded poorly to corticosteroid treatment. In another patient, who died of myocardial infarction one year after the onset of TA, a clinically silent brain tumour was found on autopsy. In the third patient a malignant lymphoma occurred 4 years after the diagnosis of PMR was made, and in the fourth case TA and PMR preceded the discovery of a metastasizing adenocarcinoma of unknown origin by 3 years. In the latter three cases the long interval between the onset of the poiymyalgic symptoms and the discovery of malignancy and the excellent response to steroid treatment were not consistent with a paraneoplastic mechanism of the rheumatic symptoms. The observed incidence of neoplasms during the follow-up period in this material did not differ significantly from the anticipated number of neoplasms in the same age groups of the normal population.