Self-mutilation and behavioural disorder.

2In order to normalise the ESR and stabilise the arterial lesions, these patients were given daily doses of steroids higher than the standard for GCA (¢ 1 mg/kg). Most of them showed significant improvements in claudication and pulses (60%). Although the pulses were not recovered in cases with total vascular thrombosis, amputation of the involved limb was avoided.4 The mean response time was 2-4 weeks. Finally, this case emphasises the need to exclude GCA when ischaemia of the limbs occurs within a toxic inflammatory picture. It also emphasises the importance of excluding this type of complications in a patient with a known GCA, before attributing them to polymyalgia rheumatica. Learning points