Suspected GCA in patients with PMR

In which patients with polymyalgia rheumatica (PMR) should we suspect giant cell arteritis (GCA)?

Bhaskar Dasgupta: PMR can be a presentation of large-vessel GCA. These patients may have typical polymyalgic symptoms, but what distinguishes large-vessel vasculitis from simple PMR is that these patients have a lot of constitutional symptoms. They have considerable weight loss, night sweats, and may have low-grade fever. These patients tend to have high levels of inflammatory markers, so their C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) tend to be high. Moreover, these patients do not always respond to steroids. We find that they are having frequent flares, [which are] difficult to treat.

Therefore, in patients with PMR who are difficult to treat, have raised inflammatory marker levels, and have constitutional symptoms – particularly night sweats – we always suspect large-vessel vasculitis.