Overview
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are inflammatory conditions affecting medium and large arteries and musculoskeletal structures, respectively, often requiring glucocorticoid therapy. 12Diagnosis
Clinical Presentation: Inflammatory back pain, headache, jaw claudication in GCA, elevated inflammatory markers (ESR, CRP). 2
Temporal Artery Biopsy: Recommended for definitive diagnosis of GCA when feasible. 2
Imaging: Ultrasound of temporal arteries may support diagnosis in GCA. 2
Referral Criteria: Early referral to rheumatologists based on clinical suspicion and biomarker elevation. 2Management
First-Line Treatment: High-dose glucocorticoids (prednisolone typically starting at 40-60 mg/day) initiated promptly. 2
Glucocorticoid Tapering: Slow reduction to minimize relapse risk; specific tapering protocols vary but aim for gradual decrease. 2
Monitoring: Regular monitoring of inflammatory markers and side effects of glucocorticoids. 2
Support Services: Patient education on glucocorticoid management, side effects, and tapering strategies is crucial. 1Special Populations
Elderly: Commonly affected; careful monitoring of glucocorticoid side effects essential. 12
Comorbidities: Management requires consideration of coexisting conditions; collaborative care between GPs and rheumatologists recommended. 2Key Recommendations
Early Referral and Collaborative Care: Establish formal collaborative care pathways between GPs and rheumatologists for timely diagnosis and management of PMR and GCA. (Evidence: Strong 2)
Temporal Artery Biopsy When Possible: Perform temporal artery biopsy to secure diagnosis in suspected GCA cases where feasible. (Evidence: Moderate 2)
Patient Education on Glucocorticoids: Provide comprehensive support and education to patients regarding glucocorticoid use, tapering, and side effect management. (Evidence: Expert opinion 1)References
1 Muller S, O'Brien A, Helliwell T, Hay CA, Gilbert K, Mallen CD et al.. Support available for and perceived priorities of people with polymyalgia rheumatica and giant cell arteritis: results of the PMRGCAuk members' survey 2017. Clinical rheumatology 2018. link
2 Quick V, Kirwan JR. Our approach to the diagnosis and treatment of polymyalgia rheumatica and giant cell (temporal) arteritis. The journal of the Royal College of Physicians of Edinburgh 2012. link