Vasculitis

Biopsy

Dermatology

Radiology

Polymyalgia rheumatica

Internal medicine

Arteritis

Medicine

Disease

Giant cell arteritis

Pathology

Nature Reviews Rheumatology

Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are inflammatory disorders that commonly occur in the elderly and whose disease patterns variably overlap. In this Review, Salvarani and colleagues describe the main clinical features of both PMR and GCA, detailing the pathogenesis, diagnosis, classification and management of these disorders, offering practical guidance to clinicians. Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are inflammatory diseases that typically affect white individuals >50 years. Women are affected ∼2–3 times more often than men. PMR and GCA occur together more frequently than expected by chance. The main symptoms of PMR are pain and stiffness in the shoulders, and often in the neck and pelvic girdle. Imaging studies reveal inflammation of joints and bursae of the affected areas. GCA is a large-vessel and medium-vessel arteritis predominantly involving the branches of the aortic arch. The typical clinical manifestations of GCA are new headache, jaw claudication and visual loss. PMR and GCA usually remit within 6 months to 2 years from disease onset. Some patients, however, have a relapsing course and might require long-standing treatment. Diagnosis of PMR and GCA is based on clinical features and elevated levels of inflammatory markers. Temporal artery biopsy remains the gold standard to support the diagnosis of GCA; imaging studies are useful to delineate large-vessel involvement in GCA. Glucocorticoids remain the cornerstone of treatment of both PMR and GCA, but patients with GCA require higher doses. Synthetic immunosuppressive drugs also have a role in disease management, whereas the role of biologic agents is currently unclear.

Clinical features of polymyalgia rheumatica and giant cell arteritis