The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme.htm

Jerry Tenenbaum, MD, FRCPC, Professor of Medicine, University of Toronto; Consultant in Rheumatology, Mount Sinai Hospital, University Health Network, Baycrest Geriatric Centre, Toronto, ON.

Musculoskeletal inflammatory conditions in the older patient cover the spectrum of those conditions affecting all age groups to those that are associated with advanced age. Polymyalgia rheumatica and pseudogout are two conditions which are seen predominately in older adults. While gout occurs more often in males in younger patients, both genders may present in the older population. Myositis in an older patient is more likely to be associated with neoplasia, so a search for common tumours should comprise part of the workup of that patient. Hypertrophic pulmonary osteoarthropathy associated with malignancy should be considered in the older patient who presents with arthritis, long bone pain, and clubbing. Osteoarthritis is by far the most common arthritis in the older population. It is important to identify those patients who have clinical features of inflammation in order to provide that subgroup with appropriate anti-inflammatory treatment.

Key words: polymyalgia rheumatica, pseudogout, synovitis, osteoarthritis, myositis.

D'Arcy Little, MD, CCFP
Director of Medical Education,
York Community Services,
Toronto, ON.

Introduction and Historical Background
Although first described in 1888 as "senile rheumatic gout," it wasn't until the 1950s when more cases were described in the literature that Barber coined the term "Polymyalgia rheumatica" to describe a syndrome of myalgias, stiffness of the shoulder and pelvic girdle muscles, and concomitant constitutional symptoms. A case of Temporal arteritis was first described by Thomas Hutchinson in 1890 when an 80-year-old man presented with a painful, inflamed temporal artery. In 1932, Horton first described the typical histological features of temporal artery from biopsies in patients with this condition, and the term "Giant cell arteritis" was first used.^1,2,3

Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are closely related conditions that are almost always seen in patients over the age of 50 years. These conditions are relatively common and may represent a continuum of disease.^3,4 The following review will provide a framework for consideration of these diagnoses, as well as a review of their treatments.

Epidemiology
Once considered uncommon, PMR and GCA are among the most common, chronic inflammatory illnesses affecting the elderly, primarily as a result of raised awareness of the conditions.⁴ PMR has an incidence in North America of 52.