There may be fever and depression. Headache is common. The disease is almost unknown in blacks and in persons under 50. This illness was described by Dr. Bruce at Strathpepper Spa in Scotland in 1888. He called it senile rheumatic gout, but it has gone under many names.
Diagnosis is by excluding other diseases and by an unusual clue.
The sedimentation rate of anticoagulated red blood cells in a 200 mm tube is normally 20 millimeters or less in one hour. In this disease the rate is 40 mms or sometimes more than 100. The disease is self-limited lasting a year with a range of 2 to 54 months. It does not shorten life, but treatment is needed to control pain and to prevent a serious complication. In 1890, Jonathan Hutchison, a surgeon at the London Hospital, described an elderly hospital aide who could not wear his hat because of painful red inflamed arteries in both temples.