Last reviewed: 23 Dec 2020
Last updated: 06 Jun 2018



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

  • over 50 years
  • giant cell arteritis (GCA)
  • female gender

Diagnostic investigations

1st investigations to order

  • ESR
  • C-reactive protein (CRP)
  • CBC
  • ultrasound
More 1st investigations to order

Investigations to consider

  • TSH
  • MRI
  • serum protein electrophoresis
  • serum creatine phosphokinase
More investigations to consider

Emerging tests

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

Treatment algorithm


Associate Chief of Rheumatology

VA Greater Los Angeles Healthcare System

Associate Clinical Professor of Medicine

David Geffen School of Medicine at UCLA

Los Angeles



AW declares that he has no competing interests.

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

Peer reviewersVIEW ALL

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




BFM declares that he has no competing interests.

Consultant Rheumatologist

BHRT University Hospital

Queen’s Hospital




KC declares that he has no competing interests.

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