A review of 80 patients with the polymyalgia rheumatica/giant cell arteritis (PMR/GCA) syndrome has revealed that the erythrocyte sedimentation rate (ESR) is normal in 22.5% of cases at presentation. Too much reliance on the ESR as a screening test led to delay in diagnosis in 10 patients. Serious complications occurred in 4 patients with a normal or minimally raised ESR. Analysis of follow-up data at 4 weeks showed no significant correlation between change in the ESR and change in symptoms, and at subsequent clinical attendances symptoms did not consistently parallel the ESR. Our results cast serious doubts on the use of the ESR as an entirely reliable diagnostic and therapeutic aid in the PMR/GCA syndrome.
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