TEMPORAL ARTERITIS AND POLYMYALGIA-RHEUMATICA - NOSOGRAPHIC AND NOSOLOGIC CONSIDERATIONS

Original reports on temporal arteritis and polymyalgia rheumatica were reviewed before and after the introduction of steroid therapy to prev ent blindness in temporal arteritis. In some cases, the original data were reworked. There is evidence that both diseases have become more b enign. As a result, the perceived risk of blindness is presently overe stimated, as is the perceived benefit of steroids in reducing this ris k, and neither should be used as support for an essential difference b etween temporal arteritis and polymyalgia rheumatica. Indeed, no quali tative differences otherwise exist and both are best viewed as facets of a common disease spectrum with variable risk of adverse outcome. So me of the difficulties in dealing with diseases characterized by varia ble risk within present dichotomous classifications are discussed. It is Likely that in many patients benign disease is presently undiagnose d. It is likely that certain classifications of temporal arteritis and polymyalgia rheumatica now in use lead to an overtreatment of some pa tients with relatively benign disease.