Polymyalgia rheumatica (PMR) is a relatively common disease of the elderly affecting the synovial membrane.1

Recent studies have emphasised the prominent involvement of the extra-articular synovial structures in both proximal and distal regions of both the arms and legs.1-7 In the distal part of the arms tenosynovial membrane inflammation is responsible for carpal tunnel syndrome, distal swelling of hands and feet with or without pitting oedema, and localised episodes of distal tenosynovitis.4-7

We recently observed the case of a patient with PMR showing retrocalcaneal bursitis, which we describe briefly here.

A 68 year old woman was referred to us for evaluation of a three month history of marked aching and morning stiffness in her neck, shoulder, and hip girdles associated with low grade fever. Her medical history was otherwise unremarkable except for a hereditary cerebellar cortical degeneration. Her family history was negative for rheumatic diseases, including spondarthritis.

Physical examination showed tenderness and limitation of cervical and shoulder movement. The typical gait and abnormal stance of cerebellar ataxia were also present.

Laboratory evaluation disclosed an erythrocyte sedimentation rate (ESR) of 72 mm/1st h (Westergren) and a C reactive protein (CRP) concentration of 80 mg/l (normal <5). Tests for rheumatoid factor, antinuclear antibodies, and serum tumour markers were negative, and HLA typing did not show the B27 antigen.

Methylprednisolone at a dose of 16 mg/day was started and symptoms rapidly disappeared. ESR and …