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Methotrexate in Polymyalgia Rheumatica: Kernel of Truth or Curse of Tantalus?

John H. Stone, MD, MPH
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From The Johns Hopkins Vasculitis Center, Baltimore, MD 21224.


Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: John H. Stone, MD, MPH, The Johns Hopkins Vasculitis Center, 5501 Hopkins Bayview Circle, 1B.23, Baltimore, MD 21224; e-mail, jstone@jhmi.edu.


Ann Intern Med. 2004;141(7):568-569. doi:10.7326/0003-4819-141-7-200410050-00015
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In Greek mythology, King Tantalus, a son of Zeus, was a mortal favored by the gods. Invited to share ambrosia—food of the gods—Tantalus committed some unspecified breach of protocol, leading swiftly to his downfall. The unfortunate king was consigned to the lower world, there to undertake his punishment: eternal immersion in water up to his neck. More diabolically, whenever Tantalus tilted his head to drink, the water drained away. Although luscious fruit hung above him on trees, whenever he extended his arms to grasp it, winds blew the branches beyond reach. From Tantalus's name comes the English verb tantalize. In this issue, readers must decide whether Caporali and colleagues' randomized, double-blind, placebo-controlled trial of methotrexate in polymyalgia rheumatica (1) reveals a kernel of truth about methotrexate or bespeaks the curse of Tantalus: a desirable result placed just beyond the reach of those who would grasp it.

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Tantalus' Curse
Posted on October 22, 2004
Mark H. Beers
Merck Research Laboratories
Conflict of Interest: None Declared

In the October 5th issue of The Annals, Dr. Stone references the Curse of Tantalus and states that the king's punishment was for "some unspecified breach of protocol." In at least one well-known version, Tantalus' breach was to serve the boiled remains of his son to the gods. He did this to test their ability to see and know all things. They did; he didn't. The take-home message to the ancients was to avoid trying to outsmart the gods. However, as medical researchers, we strive everyday to do just that. We must hope for a better reward.

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