A 65 year old woman presented in February 1998 with joint pains, mild weight loss, and a low grade irregular fever. Initially, pain was localised around both shoulder joints. Subsequently, elbows, wrists, hips, and knees were affected, with morning stiffness, but without particular swelling. The symptoms were accentuated by movement, but also persisted during the night, often keeping the patient awake. On clinical examination, there was limited painful movement of the shoulders and hips, with a marked reduction in strength. The small joints of the hands and feet were not affected. No other pathological conditions were found. Laboratory findings showed a marked increase in erythrocyte sedimentation rate (ESR; >100 mm/1st h), hyper-α₂ globulinaemia and a mild anaemia, whereas enzymatic activity (serum aspartate aminotransferase, serum alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase, and creatine kinase) was within the normal range. A diagnosis of polymyalgia …