A patient with recurrent oedema of the hands and a collapse

Editor – I had a correction to make in the case report by Chowdhury et al (Clin Med Feb 2011 pp 65–6) regarding the dose of steroid needed to treat polymyalgia rheumatic (PMR). The usual dose of prednisolone for PMR is 15 mg/day and not higher as wrongly suggested by the case report. In the case of RS3PE the usual starting dose is in fact not more than 7.5 mg per day. I feel this is important to point out since being a rheumatologist and an acute physician, I have found patients in the acute admission unit, who have been diagnosed to have PMR, are started on high doses of prednisolone by the acute physicians. The only reason to prescribe a higher dose than 20 mg per day would be if patients presented with features suggesting temporal arteritis, such as temporal headaches, scalp tenderness, jaw claudication and associated problems with vision.