Should we look for giant cell arteritis in typical polymyalgia rheumatica?

Bhaskar Dasgupta, MD, is a professor of rheumatology at Southend University Hospital, UK, and honorary professor of Essex University, UK.

Should we actively look for giant cell arteritis (GCA) in a patient with typical polymyalgia rheumatica (PMR)?

You do not need to look for GCA in a patient with typical PMR, but you should definitely look for GCA in patients with relapsing PMR, so patients who have been treated with steroids and [in whom] as you reduce the steroids, the symptoms come back; in patients who have constitutional symptoms, so these are patients with PMR who are losing weight, who have got drenching sweats or low-grade fever.

We should look for GCA in patients with PMR with very high levels of inflammatory markers. We should be looking for GCA in patients who have back pain associated with symptoms of PMR, because back pain is a sign of aortitis. Definitely we should be looking for GCA in patients, for example, who have upper limb claudication, so patients who have got vascular claudication of the arms.

Yes, more and more we should be looking for GCA in most patients with PMR unless they are doing very well with a low dose of steroids.