Polymyalgia rheumatica in patients with a normal erythrocyte sedimentation rate

Arthritis Rheum. 1996 Feb;39(2):304-7. doi: 10.1002/art.1780390220.


Objective: To ascertain the frequency of polymyalgia rheumatica (PMR) with a normal erythrocyte sedimentation rate (ESR; < or = 30 mm/hour) and to determine any defining clinical characteristics.

Methods: A retrospective chart review study of all patients meeting the clinical criteria for PMR seen over a 5-year period in a hospital and an office-based rheumatology practice.

Results: We evaluated 117 patients; 26 (22.2%) had a pretreatment ESR of < or = 30 mm/hour (mean +/- SD 19.8 +/- 7.5 versus 74.4 +/- 30.3 mm/hour for elevated ESR group; P<0.0001). Of the 26 normal ESR patients, 15 (58%) were female compared with 74 of the 91 elevated ESR patients (81%) (P<0.02, by Fisher's exact test). The mean hemoglobin concentration was significantly lower in the elevated ESR population (mean +/- SD 1.23 +/- 0.15 gm/liter versus 1.38 +/- 0.11 gm/liter; P<0.0001). The duration of symptoms prior to treatment with prednisone was significantly longer for patients with a normal ESR (149 +/- 95 days versus 103 +/- 95 days for elevated ESR patients; P<0.04).

Conclusion: In our series, PMR with a normal ESR accounted for approximately one-fifth of all PMR patients, more commonly in men. The lack of characteristically abnormal laboratory findings may result in a delay in the proper diagnosis and management of this condition.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Sedimentation*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Polymyalgia Rheumatica / blood*
  • Reference Values
  • Retrospective Studies
  • Sex Characteristics