Polymyalgia rheumatica and giant cell arteritis overlap, and missing arteritis risks permanent visual loss. Every patient presenting with polymyalgia should be asked about cranial and systemic features before low-dose steroids are started.
Polymyalgia also has many mimics, including late-onset rheumatoid arthritis, malignancy and infection, so a poor or partial response to low-dose steroids is a reason to reconsider the diagnosis.
- Ask about new headache, scalp tenderness, jaw claudication and visual disturbance.
- Ask about fever, weight loss and limb claudication, which can signal large-vessel involvement.
- Examine temporal arteries and check both radial pulses and arm blood pressures.
- Reconsider the diagnosis if symptoms do not respond well to low-dose steroids within a few weeks.
Why it matters
Polymyalgia doses of steroid will not protect the eyes of a patient with unrecognised arteritis.
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