Last reviewed: 5 Jul 2021
Last updated: 14 Jul 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • shoulder/hip girdle stiffness
  • shoulder/hip girdle pain
  • rapid response to corticosteroids

Other diagnostic factors

  • acute onset
  • low-grade fever
  • anorexia
  • weight loss
  • malaise
  • depression
  • asthenia
  • oligoarticular arthritis

Risk factors

  • age ≥50 years
  • giant cell arteritis (GCA)
  • female sex

Diagnostic investigations

1st investigations to order

  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • FBC

Investigations to consider

  • TSH
  • ultrasound
  • MRI
  • serum protein electrophoresis
  • rheumatoid factor
  • anti-cyclic citrullinated peptide antibodies

Emerging tests

  • interleukin (IL)-6
  • fluorodeoxyglucose F-18 PET scan

Treatment algorithm

Contributors

Authors

Ari Weinreb, MD, PhD

Associate Chief of Rheumatology

VA Greater Los Angeles Healthcare System

Associate Clinical Professor of Medicine

David Geffen School of Medicine at UCLA

Los Angeles

CA

Disclosures

AW declares that he has no competing interests.

Acknowledgements

Dr Ari Weinreb would like to gratefully acknowledge Dr Lynell Newmarch, a previous contributor to this topic. LN declares that she has no competing interests.

Peer reviewers

Brian F. Mandell, MD, PhD, FACR

Vice Chairman of Medicine for Education

Professor of Medicine

Cleveland Clinic Lerner College of Medicine

Case Western Reserve University

Editor in Chief

Cleveland Clinic Journal of Medicine

Cleveland Clinic

Cleveland

OH

Disclosures

BFM declares that he has no competing interests.

Kuntal Chakravarty, FRCP (London), FRCP (Glasgow), FRCP (Ireland), FACP (USA), FACR (USA)

Consultant Rheumatologist

BHRT University Hospital

Queen’s Hospital

Romford

UK

Disclosures

KC declares that he has no competing interests.

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