History of Polymyalgia rheumatica

Polymyalgia rheumatica emerged as a recognized clinical entity only in the twentieth century, despite the likelihood that physicians in earlier eras had encountered the condition without possessing the conceptual framework necessary to identify it as a distinct disease. The condition's history was closely intertwined with the history of giant cell arteritis, a vascular inflammation with which it frequently coexisted, and the two conditions were gradually disentangled through careful clinical observation and pathological investigation during the mid-twentieth century. The story of how polymyalgia rheumatica achieved diagnostic identity illustrated how diseases were constructed as much as discovered through the accumulation and organization of clinical experience.

Historical Narrative

Because polymyalgia rheumatica produced no visible external signs and its characteristic features required systematic clinical observation to recognize as a coherent syndrome, it left no clear trace in ancient or medieval medical literature. Historians examining pre-modern sources have been unable to identify any ancient Greek, Roman, or Islamic medical text that described a presentation clearly recognizable as the condition. This silence in the historical record likely reflected the absence of the clinical and conceptual tools necessary to distinguish the condition from the broad category of rheumatic complaints that dominated pre-modern descriptions of musculoskeletal suffering.

The condition's first clear emergence in the medical literature occurred in 1888, when the British physician William Bruce published a description of what he called 'senile rheumatic gout,' a term he applied to cases of severe pain and stiffness in older patients that he found difficult to classify within existing categories. Bruce's account was largely forgotten, and the condition did not attract sustained attention for several more decades.

The mid-twentieth century brought a series of clinical reports that gradually coalesced into a recognized syndrome. In 1945, the British physician Lancelot Barber described a cluster of cases under the term 'periarthrosis humeroscapularis,' emphasizing involvement of the shoulder region. A more influential contribution came from the Scottish physician Hinds Howell, who published observations in 1957 describing what he termed 'polymyalgia arteritica,' explicitly connecting severe proximal muscle pain and stiffness in elderly patients with temporal arteritis, a vascular inflammation that had been described separately by the ophthalmologist Jonathan Hutchinson in 1890 and subsequently characterized pathologically by Bayard Taylor Horton and colleagues in the 1930s.

The term 'polymyalgia rheumatica' itself was coined by the British physician Leslie Barber in 1957, providing the nomenclature that eventually achieved international acceptance. The adoption of this name reflected a deliberate choice to identify the condition by its clinical presentation rather than its postulated mechanism, acknowledging that the underlying pathophysiology remained poorly understood. Debate persisted for years about whether polymyalgia rheumatica and giant cell arteritis represented distinct diseases, closely related conditions, or manifestations of a single pathological process occurring at different sites, and this controversy occupied rheumatologists and pathologists through the 1960s and 1970s.

The development of the erythrocyte sedimentation rate as a routine laboratory measurement, work advanced in the early twentieth century by the Polish pathologist Edmund Biernacki and subsequently promoted by the Swedish physician Alf Westergren, provided clinicians with an objective marker that elevated strikingly in polymyalgia rheumatica cases. This laboratory finding became central to the condition's clinical characterization and helped persuade skeptical physicians that they were dealing with a genuine pathological entity rather than a loose collection of nonspecific complaints.

The introduction of corticosteroids in the early 1950s, following Philip Hench and Edward Kendall's Nobel Prize-winning work on cortisone at the Mayo Clinic, produced rapid and dramatic symptomatic resolution in polymyalgia rheumatica patients, a response that served as retrospective confirmation that the condition involved genuine inflammatory processes. This therapeutic observation shaped subsequent understanding of the condition's biological nature and secured its place as a recognized entity within the emerging specialty of rheumatology.

Key Historical Figures

• William Bruce
• Lancelot Barber
• Leslie Barber
• Hinds Howell
• Jonathan Hutchinson
• Bayard Taylor Horton
• Edmund Biernacki
• Alf Westergren
• Philip Hench
• Edward Kendall

Historical narrative only — this page describes how Polymyalgia rheumatica was understood historically. It is not medical advice and does not describe current diagnosis or treatment. Sourced from verified medical history references (NIH, Encyclopaedia Britannica, and standard medical history texts). See our medical disclaimer.