An international, multidisciplinary task force of 30 members from 12 countries, following EULAR procedures and a systematic literature review, has developed the first evidence-based recommendations for imaging in polymyalgia rheumatica: three overarching principles and seven recommendations, agreed by vote.
Polymyalgia remains a clinical diagnosis. Imaging is not needed to confirm it when clinical probability is high, or to exclude it when probability is low; it is most useful at intermediate probability, such as atypical presentations or suspected overlapping conditions. No single modality — ultrasound, MRI or FDG-PET — was accurate enough to be recommended first-line, so the choice should depend on the clinical picture, alternative diagnoses, access and local expertise. Vascular imaging should be done when giant cell arteritis is suspected, but routine screening for subclinical vasculitis is not supported. Imaging is not recommended for monitoring or predicting outcome.
For many clinics, especially where PET is costly or far away, this is permission not to scan the typical patient, and a framework for when a scan is worth it.
- Diagnose typical polymyalgia clinically; imaging is not required to confirm it.
- Reserve imaging for atypical presentations or when an alternative or overlapping condition is suspected.
- Choose ultrasound, MRI or PET according to the question, access and local expertise.
- Arrange vascular imaging when giant cell arteritis is suspected, not as routine screening.
- Do not use imaging to monitor polymyalgia or predict relapse.
Why it matters
It sets a clear default against routine scanning while defining when imaging changes the diagnosis.
Don't overread it
Recommendations partly rest on expert consensus where evidence was limited.
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