Summary
Definition
History and exam
Key diagnostic 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 tests
1st tests to order
- erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- CBC
Tests to consider
- TSH
- ultrasound
- MRI
- serum protein electrophoresis
- serum creatine phosphokinase
- rheumatoid factor
- anti-cyclic citrullinated peptide antibodies
Emerging tests
- interleukin (IL)-6
- fluorodeoxyglucose F-18 PET scan
Treatment algorithm
initial presentation
treatment-resistant or relapse or disease exacerbation
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.
Disclosures
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.
References
Key articles
Nothnagl T, Leeb BF. Diagnosis, differential diagnosis and treatment of polymyalgia rheumatica. Drugs Aging. 2006;23:391-402. Abstract
Buttgereit F, Dejaco C, Matteson EL, et al. Polymyalgia rheumatica and giant cell arteritis: A systematic review. JAMA. 2016 Jun 14;315(22):2442-58. Abstract
Dejaco C, Singh YP, Perel P, et al; European League Against Rheumatism; American College of Rheumatology. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheumatol. 2015;67:2569-2580.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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