Body mass index and mortality in the elderly.

Occurrence of polymyalgia rheumatica in rheumatoid arthritis Polymyalgia rheumatica and rheumatoid arthritis may be difficult to differentiate in elderly patients.Polymyalgic symptoms are common in the prodromal phase of rheumatoid arthritis and, as specific diagnostic tests do not exist for either condition, criteria for diagnosis of the diseases are based largely on clinical features.I 2 The presence ofsynovitis similar to rheumatoid arthritis in some patients with polymyalgia rheumatica causes further problems.3It is generally thought, however, that polymyalgia rheumatica does not occur in patients with rheumatoid arthritis; indeed, a diagnosis of rheumatoid arthritis has been used as a criterion for excluding polymyalgia rheumatica.34We report the occurrence of polymyalgia rheumatica in patients who already had rheumatoid arthritis. Case reportsFive patients with previously established classical rheumatoid arthritis devel- oped typical polymyalgia rheumatica; they rapidly became incapacitated by the symptoms of polymyalgia when their rheumatoid arthritis was well controlled or quiescent.Their shoulders had not been affected previously.The onset of polymyalgia was sudden (less than two weeks in three patients), and rheumatoid arthritis in the joints previously affected did not worsen.No patient showed evidence of a recent bacterial or viral infection or responded when their non- steroidal anti-inflammatory drugs were changed, but all patients responded to prednisolone.The table summarises the clinical features of the five patients and indicates the presence of the criteria for diagnosis of polymyalgia rheumatica as evaluated by Bird et al'; the presence of three out of seven criteria strongly suggests polymyalgia rheumatica.None of our patients was able to turn over in bed, and all had a considerably higher erythrocyte sedimentation rate than had 1 Bird HA, Esselinckx W, Dixon AStJ, et al.An evaluation of criteria for polymyalgia rheumatica.