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Pmr and gca steroids or bust

Corticosteroid treatment is predominantly for symptom control, and there is no clear evidence that it will alter the natural history of the condition, which is largely self-limiting. Once all other differential diagnoses have been considered, the patient should be assessed for response to an initial dose of prednisone, 15 mg, daily. If the patient reports a significant improvement in their symptoms within one week, this is consistent with polymyalgia rheumatica, and treatment can continue.

The British Society for Rheumatology guidelines suggests the following method for titrating the dose of prednisone in people with polymyalgia rheumatica: 6. If the patient is at higher risk of adverse effects from long-term steroid use, e. If symptoms of polymyalgia rheumatica reoccur during the dose tapering period, return the patient to their previous steroid dose and then re-start the taper again from that point.

Some patients will require treatment with low-dose corticosteroids for two to three years due to recurrent relapses. Vitamin D supplements should be prescribed alongside long-term corticosteroid treatment for all people with polymyalgia rheumatica. Adequate dietary calcium, or supplementation if this is not possible, is also necessary.

Bisphosphonates should be considered in patients with a previous history of fragility fractures or reduced bone-mineral density. A proton pump inhibitor PPI , such as omeprazole may be considered for people who experience adverse gastrointestinal affects when taking prednisone.

For further information, see " Practical consideration when prescribing long-term corticosteroids ". Early follow-up to assess the response to treatment is recommended. A follow-up consultation should be scheduled within a few days after starting corticosteroid treatment, and then further follow up appointments scheduled one, two, three and six weeks later, where possible.

Follow-up should then occur once every three months for the duration of corticosteroid treatment. A history and clinical examination including an assessment for symptoms and signs of giant cell arteritis, such as scalp tenderness, temporal artery tenderness and new-onset or new type of headache, should be included in each follow-up.

If symptoms of giant cell arteritis arise, the patient should be presumed to have the condition, and referred to secondary care for temporal artery biopsy. Clinical signs and symptoms are the primary marker for relapse, with laboratory tests providing supporting information only.

Relapses of polymyalgia rheumatica symptoms should be treated with a return to the higher, previous dose of prednisone. The dosing and monitoring regimen should be decided upon in consultation with the Rheumatologist. Methotrexate is usually continued until the corticosteroids can be tapered without the recurrence of polymyalgia rheumatica symptoms.

After two months, an HbA 1c test can be used. Corticosteroids are associated with significant adverse effects and they must be slowly tapered rather than stopped abruptly. The lowest effective dose should be used, then tapered and stopped as soon as possible.

The following practice points should be considered whenever a patient is prescribed corticosteroids long-term: 9. Tapering must be done carefully to avoid relapses of the condition and potential adrenal deficiency resulting from hypothalamic-pituitary-adrenal axis HPA suppression. Higher doses of corticosteroid, e. Higher doses also increase the likelihood of adverse affects.

The taper is usually started as soon as symptoms are under control. The individual condition being treated will alter the length of the taper, e. Older age, higher cumulative doses of corticosteroids and female sex increase the risk of adverse effects occurring. Calcium supplementation is also recommended, but there have been concerns that calcium supplementation may increase cardiovascular risk, particularly in older people. If calcium supplementation is required, oral calcium carbonate 1.

Ideally a bone-mineral density BMD scan of the lumbar spine and hip should be requested for patients when starting long-term corticosteroids, however, this depends on the availability and funding of the local service, e. Alendronate, 70 mg, once weekly, should be taken first thing in the morning, on an empty stomach, with a full glass of water to ensure adequate absorption.

Zoledronic acid, 5 mg IV infusion over 15 minutes, once per year is an alternative. The patient should have their renal function assessed prior to starting, and be informed that dizziness and influenza-like symptoms are common after infusion. The Special Authority requirements for the initial application for either alendronate or zoledronic acid require that:. If a funded bisphosphonate is required, but the patient does not meet the Special Authority requirements of alendronate or zoledronic acid, etidronate disodium may be used, however, etidronate is significantly weaker than either alendronate or zoledronic acid.

Etidronate disodium is prescribed at mg, daily on and empty stomach, for 14 days, repeated every three months. Risedronate, an alternative to alendronate, is to be listed on the Pharmaceutical Schedule, without restrictions, from 1 September, Follow us on facebook. Decision support for health professionals ». South Island general practice support ». Practice acquisition and careers in health ». Click here to register ». Forgot your login?

Login to my bpac. Remember me. Musculoskeletal Pain management Rheumatology. Polymyalgia rheumatica: Look before you leap Polymyalgia rheumatica is an inflammatory condition that causes a particular pattern of joint pain and stiffness, most commonly in older people. In this article What is polymyalgia rheumatica? Making a diagnosis Treatment of polymyalgia rheumatica Follow-up of people with polymyalgia rheumatica Practical considerations when prescribing long-term corticosteroids References In this article.

What is polymyalgia rheumatica? Never trust a diagnosis of polymyalgia rheumatica As polymyalgia rheumatica has a non-specific clinical presentation and few significant sequelae, it should be diagnosed with caution. Making a diagnosis The British Society for Rheumatology has developed a set of inclusion and exclusion criteria for diagnosing polymyalgia rheumatica.

Stiffness Marked morning stiffness that persists for at least 45 minutes is typical for people with polymyalgia rheumatica. Systemic symptoms and signs Systemic features may be present in approximately one-third of patients and include low grade fever, malaise, anorexia and weight loss.

Peripheral symptoms Symptoms, such as pain or stiffness in the joints of the hands and feet, are present in approximately half of people with polymyalgia rheumatica, however, peripheral symptoms are also common in other, similar conditions, such as rheumatoid arthritis and other inflammatory arthritides. Giant cell arteritis symptoms Always specifically enquire about symptoms that may suggest giant cell arteritis, such as unilateral temporal headaches, scalp tenderness, jaw claudication or visual symptoms.

Differential diagnosis The differential diagnosis of polymyalgia rheumatica is critically important, particularly for atypical cases, or where inflammatory markers are normal. Conditions that should be considered include: 3, 6 Giant cell arteritis Malignancy Rheumatoid arthritis and other arthritides Endocrine and iatrogenic causes of proximal myopathy, e.

Imaging is not essential for diagnosis If ultrasound is accessible, assessment of the shoulder and hip joints can be considered. Distinguishing polymyalgia rheumatica from rheumatoid arthritis Rheumatoid arthritis can be a challenging condition to differentiate from polymyalgia rheumatica, particularly in patients who are subsequently found to have seronegative or late-onset rheumatoid arthritis.

If there is still doubt about the diagnosis, anti-CCP antibodies may be useful. Treatment of polymyalgia rheumatica Corticosteroids are the first-line treatment for polymyalgia rheumatica. Follow-up of people with polymyalgia rheumatica Early follow-up to assess the response to treatment is recommended. Practical considerations when prescribing long-term corticosteroids Corticosteroids are associated with significant adverse effects and they must be slowly tapered rather than stopped abruptly.

The adverse effects of corticosteroid treatment Adverse effects of corticosteroids include: 10 Skin changes and disorders, e. References Mackie S, Pease C. Diagnosis and management of giant cell arteritis and polymyalgia rheumatica: Challenges, controversies and practical tips. Postgrad Med J. Polymyalgia rheumatica and giant-cell arteritis. Kermani T, Warrington K. Polymyalgia rheumatica. They do this by reducing the amount of acid produced naturally in the stomach.

Your regular check-ups will help to identify any side effects so that they can be treated promptly. Because steroids reduce the activity of the immune system, you may be more likely to develop infections, and they can be more serious.

For example, chickenpox and shingles can be severe in people taking steroids. Steroids are the first-line treatment to get GCA under control and prevent any serious complications. There are times when your doctor may suggest an additional medication to help you reduce the dose of steroids, this may happen if:. Alternative treatments may include conventional disease-modifying anti-rheumatic drugs DMARDs , including:.

These drugs slow down the immune system, which can be misfiring in people who have autoimmune conditions. There are also some newer drugs available, called biological therapies. These drugs target key cells within the immune system to stop them causing inflammation. Biologic treatment includes medications such as tocilizumab. Tocilizumab is used mainly to treat people with relapsing large vessel vasculitis.

At times, clinical trials of possible new treatments are carried out, and you may be offered one of these new drugs as part of a scientific study. Before agreeing to take part in one of these trials, you should make sure you fully understand what it involves by talking to your doctor. Your doctor may suggest low-strength aspirin as it helps to protect against loss of vision in GCA.

You need to discuss this with your doctor to ensure it is safe for you to take aspirin. Find out more about exercising with arthritis and what types of exercises are beneficial for certain conditions. Find out what fatigue is, what causes it and how you can manage it.

This can cause pain and stiffness especially in the muscles of the shoulders, neck, hip and thighs. Symptoms are usually worse in the morning. The pain and stiffness in your muscles may be so severe that dressing, reaching, climbing stairs or even getting out of bed may be difficult. You may also feel unwell, have a slight fever or lose weight. At times, tiredness can be overwhelming. The most common blood vessels to be affected by GCA are in the head and neck.

However, GCA can sometimes be linked with inflammation of other blood vessels, including the main artery from the heart aorta and those supplying the head, neck and arms. This is called large vessel vasculitis LVV and is usually linked with symptoms such as:. LVV is usually treated with additional drugs to suppress the immune system, such as methotrexate and leflunomide. Newer biological drugs such as tocilizumab are also being tried.

There are no particular foods that you should avoid. However, you should eat a healthy, balanced and nutritious diet, that is low in saturated fats, sugar and salt, and contains plenty of calcium and vitamin D. Talk to your doctor if you have any concerns.

Calcium and vitamin D are important to reduce the greater risk of osteoporosis from steroid treatment. Vitamin D can be obtained from some foods, especially from oily fish. Vitamin D is often added to soya milk and vegetable-based margarine.

For many people, the easiest way of getting enough vitamin D is with supplements. Vitamin D is needed to help the body absorb calcium. Vitamin D can be produced in the skin when it is exposed to sunlight during spring and summer months.

Doctors also recommend that groups at high risk of not getting enough vitamin D take supplements all year round. This includes people:. You should keep as fit and active as you can. This helps prevent osteoporosis, and may help to avoid weight gain and muscle weakness caused by the steroids. Weight-bearing exercise , such as walking or jogging, can strengthen bones and reduce the risk of osteoporosis. Fatigue can be a major problem for some people even when on treatment.

This can be a difficult symptom to manage, and rest is important, but some people find that gradual well-paced exercise can help. Pacing and planning activities and setting realistic, achievable goals can improve your energy levels and well-being. If fatigue becomes a problem, it might help to have an appointment with a specialist nurse or an occupational therapist.

Occupational therapists are healthcare professional who can help people improve their ability to do everyday tasks they might be struggling with because of a medical condition. Smoking can greatly damage bone health and make you more at risk of osteoporosis. Smoking can also increase the risk of having a stroke. Drinking too much alcohol is bad for bone health, because it makes it harder for the body to use calcium to make bones strong. I will always be incredibly grateful to the doctor I saw one night at accident and emergency who spotted the symptoms of giant cell arteritis and possibly saved my sight.

I had been to a GP surgery three days before because I was having these real bad pains in my head. I was given a date for an ultrasound scan to try to get to the bottom of what was going on, but this appointment was not for another eight weeks. I was at home in the evening three days later and my symptoms got much worse. I had real pain in my head. We went straight to the accident and emergency department at the local hospital.

I saw a lovely doctor. She heard my symptoms and gave me 60 mg of steroid tablets. After two months of steroid treatment, I was told it had cleared up. Giant cell arteritis GCA. Download versus Arthritis - Giant call arteritis information booklet. Print this page. What is giant cell arteritis GCA? GCA commonly affects arteries in the head and neck.

Related information. Who gets giant cell arteritis? The most common symptoms of GCA are: headaches, often with severe pain and tenderness over the temples and the scalp — it may be painful to brush your hair or to shave. Headaches from GCA can cause pain elsewhere in the head too.

RIS file.

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Lowest dose steroid cream Extended exposure to prednisolone is inevitable for these patients. Introduction Polymyalgia rheumatica is the second most common autoimmune rheumatic disease after rheumatoid arthritis, with a lifetime risk of 2. This can help diagnose GCA and see if there are any complications. This can cause pain and stiffness especially in the muscles of the shoulders, neck, hip and thighs. Clinical outcomes, quality of life, and diagnostic steroid organizations in the first year of polymyalgia rheumatica.
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Pmr and gca steroids or bust There are different types of vasculitis, because different blood vessels can be affected. Making a diagnosis Treatment of polymyalgia rheumatica Follow-up of people with polymyalgia rheumatica Practical considerations when prescribing long-term corticosteroids References In this article. Postgrad Med J. Vitamin D can be produced in the skin when it is exposed to sunlight during spring and summer months. Family history of rheumatoid arthritis - a non-predictor of inflammatory disease?
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Sometimes we can help them by helping them work through a topic they need to discuss with their doctor; and sometimes people are calling or writing because they are worried about a relative and want to know more to be able to help them. Calls cost the same as a normal landline call and the helpline is staffed by volunteers who give their time freely.

It contains useful leaflets published by Versus Arthritis , our newsletter, information about steroid treatment and tips for living with these conditions. If you would like a digital or a hard copy see our Information Pack page. As well as coping with the shock of finding out you have something you had never heard of, you have to come to terms with going on medication for several months at least.

Meanwhile, there is a lot that you can do to help yourself by keeping physically active and having a good level of nutrition. Even when it is ill, your body is a miraculous creation that deserves looking after! Skip to content Night mode Accessibility Search. Search for anything:. What is PMR? What is GCA? Support groups There is a growing network of support groups around the country. Although support groups operate independently, they offer similar things: Response to telephone and email enquiries.

Time to listen to, encourage and support people. Sympathetic ear and reassurance. Details of contacts across the UK. Newsletters keeping members abreast of new developments, forthcoming meetings, etc. Informal meetings to share experiences and have a chat over refreshments. Guest speakers at meetings, ie rheumatologist, ophthalmologist, dietician, etc.

Helpline support We launched the telephone Helpline at the beginning of Looking after yourself Your diagnosis of PMR or GCA may be the first time you have ever had to face the prospect of a long-term illness. Get informed. Find out whether there is a support group near you. It can be encouraging to meet another sufferer face-to-face. The study excluded some, including those who already had diabetes. So the study did not look at whether the steroids led to a worsening of pre-existing conditions, he said.

The higher incidence of cataracts in the steroid-treated group may have been due to concerns about coexistent GCA, and that might have triggered eye exams and the discovery of cataracts soon after the diagnosis, the authors noted in the article. While the findings are somewhat good news regarding side effects, steroids are often not popular among patients, Dr. Matteson noted, due to other concerns, such as the weight gain associated with steroid use. The researchers did not examine weight gain.

Nor did they look at appearance changes due to the drug or mood changes, also problematic for patients. Matteson emphasized that these findings do not mean that experts should not continue to look for a better treatment options. Types of Pain Acute Pain. Cancer Pain. Neuropathic Pain. Oral and Maxillofacial Pain. Rheumatologic and Myofascial Pain. Spine Pain. Other Types of Pain. Addiction Medicine. Complementary Treatments. Interventional Pain Management.

Manipulation and Massage. Chronic pain sufferers are using our pain specialist directory to find pain specialists in your area. Register now and get your name in front of these patients! Home » Resources » News and Research. August 18, Except for cataracts, side effects in PMR patients treated with glucocorticoids and non-PMR patients were not statistically different, new research finds.

Accessed Aug. Opioid-Induced Constipation: Treatment Modalities. Recent PPM Issues. Volume 21, Issue 4. View issue. Volume 21, Issue 3. Volume 21, Issue 2.

PROBLEM ASSOCIATED WITH STEROIDS

This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. NPS MedicineWise disclaims all liability including for negligence for any loss, damage or injury resulting from reliance on or use of this information. Read our full disclaimer. This website uses cookies. Read our privacy policy. Skip to main content.

Log in Log in All fields are required. Log in. Forgot password? How likely is it that you would recommend our site to a friend? Please help us to improve our services by answering the following question How likely is it that you would recommend our site to a friend? Please feel free to tell us why. Which of the following best describes you?

Medical Specialist. Other health profession. Which of the following best describes how frequently you visit this site? This is my first visit. Often e. Occasionally e. Rarely e. Prescribing for polymyalgia rheumatica. Aust Prescr ; Article Authors. Subscribe to Australian Prescriber. Introduction Polymyalgia rheumatica is the second most common autoimmune rheumatic disease after rheumatoid arthritis, with a lifetime risk of 2.

Clinical features The onset of polymyalgia rheumatica can be abrupt, often seemingly occurring overnight. Diagnosis The difficulty with diagnosis is accentuated by the absence of a gold standard investigation. Table 1 - Scoring algorithm for classifying polymyalgia rheumatica. Giant cell arteritis The most feared complication of polymyalgia rheumatica is giant cell arteritis. Corticosteroids Typically, untreated disease is markedly disabling due to the combination of pain, extensive stiffness and accompanying constitutional features.

Adverse effects Corticosteroids cause dose-dependent adverse effects. Steroid-sparing drugs There is great impetus to develop treatment alternatives to corticosteroids. Conclusion Polymyalgia rheumatica can be hard to diagnose and to treat optimally. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases.

Arthritis Rheum ; Polymyalgia rheumatica. Lancet ; Polymyalgia rheumatica vs late-onset rheumatoid arthritis. Rheumatology Oxford ; Ann Rheum Dis ; Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica. Polymyalgia rheumatica and giant-cell arteritis. Clinical practice. Giant-cell arteritis and polymyalgia rheumatica. N Engl J Med ; Polymyalgia rheumatica and giant cell arteritis: a systematic review.

JAMA ; Utility of 18F-fluoro-dexoxyglucose positron emission tomography for the diagnosis of polymyalgia rheumatica: a controlled study. Treatment of polymyalgia rheumatica: a systematic review. Arch Intern Med ; Glucocorticoid withdrawal in polymyalgia rheumatica: the theory versus the practice.

Clin Exp Rheumatol ; Recent advances in polymyalgia rheumatica. Intern Med J ; Corticosteroid requirements in polymyalgia rheumatica. Rheumatology 3 Expert Group. Therapeutic Guidelines: rheumatology. Version 3. Melbourne: Therapeutic Guidelines Limited; Relapse in a population based cohort of patients with polymyalgia rheumatica. J Rheumatol ; Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data.

Glucocorticoid-targeted therapies for the treatment of rheumatoid arthritis. Expert Opin Investig Drugs ; Monitoring adverse events of low-dose glucocorticoid therapy: EULAR recommendations for clinical trials and daily practice. Adverse events of low- to medium-dose oral glucocorticoids in inflammatory diseases: a meta-analysis. Efficacy and tolerability of leflunomide in difficult-to-treat polymyalgia rheumatica and giant cell arteritis: a case series.

Int J Clin Pract ; Leflunomide as a corticosteroid-sparing agent in giant cell arteritis and polymyalgia rheumatica: a case series. Biomed Res Int ; Individualization of leflunomide dosing in rheumatoid arthritis patients. Per Med ; Circulating cytokines in active polymyalgia rheumatica.

Trial of tocilizumab in giant-cell arteritis. Tissue cytokine patterns in patients with polymyalgia rheumatica and giant cell arteritis. Ann Intern Med ; Efficacy of first-line tocilizumab therapy in early polymyalgia rheumatica: a prospective longitudinal study. Brief Report: A prospective open-label phase IIa trial of tocilizumab in the treatment of polymyalgia rheumatica. Arthritis Rheumatol ; Some patients will require treatment with low-dose corticosteroids for two to three years due to recurrent relapses.

Vitamin D supplements should be prescribed alongside long-term corticosteroid treatment for all people with polymyalgia rheumatica. Adequate dietary calcium, or supplementation if this is not possible, is also necessary. Bisphosphonates should be considered in patients with a previous history of fragility fractures or reduced bone-mineral density. A proton pump inhibitor PPI , such as omeprazole may be considered for people who experience adverse gastrointestinal affects when taking prednisone.

For further information, see " Practical consideration when prescribing long-term corticosteroids ". Early follow-up to assess the response to treatment is recommended. A follow-up consultation should be scheduled within a few days after starting corticosteroid treatment, and then further follow up appointments scheduled one, two, three and six weeks later, where possible. Follow-up should then occur once every three months for the duration of corticosteroid treatment.

A history and clinical examination including an assessment for symptoms and signs of giant cell arteritis, such as scalp tenderness, temporal artery tenderness and new-onset or new type of headache, should be included in each follow-up. If symptoms of giant cell arteritis arise, the patient should be presumed to have the condition, and referred to secondary care for temporal artery biopsy.

Clinical signs and symptoms are the primary marker for relapse, with laboratory tests providing supporting information only. Relapses of polymyalgia rheumatica symptoms should be treated with a return to the higher, previous dose of prednisone. The dosing and monitoring regimen should be decided upon in consultation with the Rheumatologist.

Methotrexate is usually continued until the corticosteroids can be tapered without the recurrence of polymyalgia rheumatica symptoms. After two months, an HbA 1c test can be used. Corticosteroids are associated with significant adverse effects and they must be slowly tapered rather than stopped abruptly. The lowest effective dose should be used, then tapered and stopped as soon as possible.

The following practice points should be considered whenever a patient is prescribed corticosteroids long-term: 9. Tapering must be done carefully to avoid relapses of the condition and potential adrenal deficiency resulting from hypothalamic-pituitary-adrenal axis HPA suppression.

Higher doses of corticosteroid, e. Higher doses also increase the likelihood of adverse affects. The taper is usually started as soon as symptoms are under control. The individual condition being treated will alter the length of the taper, e. Older age, higher cumulative doses of corticosteroids and female sex increase the risk of adverse effects occurring.

Calcium supplementation is also recommended, but there have been concerns that calcium supplementation may increase cardiovascular risk, particularly in older people. If calcium supplementation is required, oral calcium carbonate 1. Ideally a bone-mineral density BMD scan of the lumbar spine and hip should be requested for patients when starting long-term corticosteroids, however, this depends on the availability and funding of the local service, e.

Alendronate, 70 mg, once weekly, should be taken first thing in the morning, on an empty stomach, with a full glass of water to ensure adequate absorption. Zoledronic acid, 5 mg IV infusion over 15 minutes, once per year is an alternative. The patient should have their renal function assessed prior to starting, and be informed that dizziness and influenza-like symptoms are common after infusion.

The Special Authority requirements for the initial application for either alendronate or zoledronic acid require that:. If a funded bisphosphonate is required, but the patient does not meet the Special Authority requirements of alendronate or zoledronic acid, etidronate disodium may be used, however, etidronate is significantly weaker than either alendronate or zoledronic acid. Etidronate disodium is prescribed at mg, daily on and empty stomach, for 14 days, repeated every three months.

Risedronate, an alternative to alendronate, is to be listed on the Pharmaceutical Schedule, without restrictions, from 1 September, Follow us on facebook. Decision support for health professionals ». South Island general practice support ». Practice acquisition and careers in health ». Click here to register ». Forgot your login? Login to my bpac. Remember me. Musculoskeletal Pain management Rheumatology. Polymyalgia rheumatica: Look before you leap Polymyalgia rheumatica is an inflammatory condition that causes a particular pattern of joint pain and stiffness, most commonly in older people.

In this article What is polymyalgia rheumatica? Making a diagnosis Treatment of polymyalgia rheumatica Follow-up of people with polymyalgia rheumatica Practical considerations when prescribing long-term corticosteroids References In this article. What is polymyalgia rheumatica? Never trust a diagnosis of polymyalgia rheumatica As polymyalgia rheumatica has a non-specific clinical presentation and few significant sequelae, it should be diagnosed with caution.

Making a diagnosis The British Society for Rheumatology has developed a set of inclusion and exclusion criteria for diagnosing polymyalgia rheumatica. Stiffness Marked morning stiffness that persists for at least 45 minutes is typical for people with polymyalgia rheumatica. Systemic symptoms and signs Systemic features may be present in approximately one-third of patients and include low grade fever, malaise, anorexia and weight loss.

Peripheral symptoms Symptoms, such as pain or stiffness in the joints of the hands and feet, are present in approximately half of people with polymyalgia rheumatica, however, peripheral symptoms are also common in other, similar conditions, such as rheumatoid arthritis and other inflammatory arthritides. Giant cell arteritis symptoms Always specifically enquire about symptoms that may suggest giant cell arteritis, such as unilateral temporal headaches, scalp tenderness, jaw claudication or visual symptoms.

Differential diagnosis The differential diagnosis of polymyalgia rheumatica is critically important, particularly for atypical cases, or where inflammatory markers are normal. Conditions that should be considered include: 3, 6 Giant cell arteritis Malignancy Rheumatoid arthritis and other arthritides Endocrine and iatrogenic causes of proximal myopathy, e. Imaging is not essential for diagnosis If ultrasound is accessible, assessment of the shoulder and hip joints can be considered.

Distinguishing polymyalgia rheumatica from rheumatoid arthritis Rheumatoid arthritis can be a challenging condition to differentiate from polymyalgia rheumatica, particularly in patients who are subsequently found to have seronegative or late-onset rheumatoid arthritis. If there is still doubt about the diagnosis, anti-CCP antibodies may be useful. Treatment of polymyalgia rheumatica Corticosteroids are the first-line treatment for polymyalgia rheumatica. Follow-up of people with polymyalgia rheumatica Early follow-up to assess the response to treatment is recommended.

Practical considerations when prescribing long-term corticosteroids Corticosteroids are associated with significant adverse effects and they must be slowly tapered rather than stopped abruptly. The adverse effects of corticosteroid treatment Adverse effects of corticosteroids include: 10 Skin changes and disorders, e.

References Mackie S, Pease C. Diagnosis and management of giant cell arteritis and polymyalgia rheumatica: Challenges, controversies and practical tips. Postgrad Med J. Polymyalgia rheumatica and giant-cell arteritis. Kermani T, Warrington K. Polymyalgia rheumatica. BMJ Best Practice. BMJ; Mitchet C, Matteson E. Larkin J. Family history of rheumatoid arthritis - a non-predictor of inflammatory disease?

Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 50yr prospective study.