Polymyalgia rheumatica and renal amyloidosis
George Dunea, M.B.
Department of Artificial Organs
Francis J. Owens, M.D.
Department of Gastroenterology
Allen H. Mackenzie, M.D.
Department of Rheumatic Disease
POLYMYALGIA rheumatica is a common but frequently unrecognized syndrome of widespread muscular and periarthritic pains, muscle stiffness, and constitutional disturbance.1–5 The cause of polymyalgia rheumatica is not known, but it is often regarded as a variant of rheumatoid arthritis,1, 3, 6 and has been designated by various names.3, 5–7 The term polymyalgia rheumatica is more suitable than any other because it carries no etiologic connotations.1, 8
Our report concerns a patient in whom renal amyloidosis developed five years after the onset of polymyalgia rheumatica. This association of diseases illustrates an unusual facet of a usually benign syndrome.
Report of a Case
A 57-year-old man was first examined at the Cleveland Clinic, in February 1963, because of pyrosis and abdominal discomfort. He had a five-year history of migratory pains in the back, chest, ankles, knees, shoulders, wrists, and neck. The pains were usually most severe at night and seemed most noticeable when he was not active. The pains in the ribs were worst on deep inspiration. Severe attacks of pain would sometimes last for several days. There was morning stiffness but no swelling of the joints. The patient had nocturnal sweating, slept badly, had lost weight, and had become depressed. Physical examination revealed no abnormality. Neither synovitis nor temporal artery tenderness was present.
Special determinations disclosed the following values: erythrocyte sedimentation rate, 1.45 mm per minute (normal, less than 0.65 mm); serum glycoprotein concentration, 200 mg per 100 ml (normal, less than 160 mg); serum uric acid content, 3.6 mg per . . .