To the Editor.—
The editorial in The Journal by George Ehrlich, MD (240:57, 1978), and the clinical report by Miller and Stevens (240:27, 1978) raise the question as to whether polymyalgia rheumatica should still be considered a diagnostic entity. Ehrlich compares polymyalgia rheumatica with rheumatoid arthritis of the elderly with the "bilateral shoulder-hand syndrome" type of presentation and concludes that these two may represent the same disease process and no distinction be made between them. He suggests that polymyalgia rheumatica should possibly be considered a part of the syndrome of rheumatoid arthritis of the elderly.His approach raises a number of problems: The presence of active synovitis has been considered sine qua non of rheumatoid arthritis since the American Rheumatism Association criteria for rheumatoid arthritis were proposed. The removal of this criterion would set back the classfication of rheumatic diseases more than 20 years. The observation of O'Duffy1 referred
Spiera H, Davison S, Plotz CM. Polymyalgia Rheumatica. JAMA. 1979;241(21):2262–2263. doi:10.1001/jama.1979.03290470014007
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