Polymyalgia rheumatica vs Giant cell arteritis
How to tell Polymyalgia rheumatica and Giant cell arteritis apart when a board question makes them look alike.
Step 2 CK pairs are in open beta while clinical review finishes. Spot an issue? Tell us.
Jaw claudication in a patient older than 50 with inflammatory pain is the fastest clue for giant cell arteritis.
Side by side
Bilateral shoulder and hip girdle morning stiffness in an older adult with high ESR and rapid response to low-dose prednisone without focal cranial ischemic symptoms.
New temporal headache with jaw claudication or transient vision loss in an older adult, requiring immediate high-dose glucocorticoids to prevent permanent blindness.
PMR reflects IL-6 driven periarticular inflammation of proximal muscles and bursae without medium-vessel occlusion.
GCA is granulomatous inflammation of medium to large arteries that narrows lumen and causes cranial ischemia.
ESR is usually >40 mm/hr, CRP is elevated, CK remains normal, and mild normocytic anemia may be present.
ESR is often >50 mm/hr with elevated CRP and thrombocytosis >400000/uL; temporal artery biopsy shows granulomatous inflammation with giant cells and intimal thickening.
The trap
Treating presumed PMR alone with low-dose prednisone when headache or visual symptoms are present delays vision-saving therapy; any transient monocular vision loss or scalp tenderness should trigger immediate high-dose steroids before biopsy.
The repair move
Next best step: start prednisone 60 mg orally now for suspected giant cell arteritis, then arrange temporal artery biopsy within 1 week and urgent ophthalmology follow-up for visual-risk monitoring.
Try a free question
CoreA 72-year-old woman has bilateral shoulder and hip stiffness for 2 months and now has new right-sided temporal headache with jaw pain while chewing. BP 150/84 mm Hg, HR 88/min, T 37.7 C, ESR 102 mm/hr. What is the next best step in management?
Show answer and explanation
Answer: A. Start prednisone 60 mg daily immediately. Cranial ischemic symptoms with very high inflammatory markers require immediate high-dose steroids for presumed giant cell arteritis.
Why the other choices are tempting
- B. Incorrect because NSAID-only treatment is inadequate for suspected giant cell arteritis.
- C. Incorrect because 15 mg prednisone is PMR dosing and is too low for cranial arteritis risk.
- D. Incorrect because treatment must not wait for biopsy when vision-threatening disease is suspected.
- E. Incorrect because CK testing does not guide urgent therapy in suspected giant cell arteritis.
Flashcards
Tap a card to flip it.
An older patient has proximal morning stiffness and ESR 65 mm/hr but no cranial symptoms; which diagnosis is more likely?
Polymyalgia rheumatica is more likely when proximal stiffness dominates and cranial ischemic symptoms are absent.
Which symptom most strongly shifts an elderly patient with inflammatory stiffness toward giant cell arteritis?
Jaw claudication or transient monocular vision loss strongly points to giant cell arteritis.
Quick answers
What is the fastest way to tell Polymyalgia rheumatica from Giant cell arteritis?
Jaw claudication in a patient older than 50 with inflammatory pain is the fastest clue for giant cell arteritis.
What is the key clue for Polymyalgia rheumatica?
Bilateral shoulder and hip girdle morning stiffness in an older adult with high ESR and rapid response to low-dose prednisone without focal cranial ischemic symptoms.
What is the key clue for Giant cell arteritis?
New temporal headache with jaw claudication or transient vision loss in an older adult, requiring immediate high-dose glucocorticoids to prevent permanent blindness.
What is the common trap with Polymyalgia rheumatica vs Giant cell arteritis?
Treating presumed PMR alone with low-dose prednisone when headache or visual symptoms are present delays vision-saving therapy; any transient monocular vision loss or scalp tenderness should trigger immediate high-dose steroids before biopsy.