It is important not to miss a diagnosis of polymyalgia rheumatica and giant cell arteritis because of the high risk of permanent blindness.
Polymyalgia rheumatica (PMR) is a common inflammatory condition of unknown aetiology. It is characterised by symmetrical stiffness of the limb girdles (shoulder and pelvic girdles) and neck. PMR is associated with giant cell arteritis (GCA; also known as temporal arteritis), a vasculitis affecting the cranial arteries. It characteristically presents with new-onset temporal headache with or without visual symptoms.
PMR and GCA rarely affect patients under the age of 50 years and are characterised by:
- constitutional symptoms, such as weight loss, fever and fatigue
- an elevated acute-phase response – that is, an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
- a typically rapid response to corticosteroids.