Polymyalgia Rheumatica vs Giant Cell Arteritis
Polymyalgia Rheumatica and Giant Cell Arteritis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Polymyalgia Rheumatica vs Giant Cell Arteritis at a glance
- Polymyalgia Rheumatica: Inflammatory syndrome of shoulder and hip girdle stiffness in adults over 50; dramatic response to low-dose steroids.
- Giant Cell Arteritis: Large- and medium-vessel vasculitis in adults over 50; threatens vision and demands empiric high-dose steroids.
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Side-by-side comparison
| Feature | Polymyalgia Rheumatica | Giant Cell Arteritis |
|---|---|---|
| At a glance | Inflammatory syndrome of shoulder and hip girdle stiffness in adults over 50; dramatic response to low-dose steroids. | Large- and medium-vessel vasculitis in adults over 50; threatens vision and demands empiric high-dose steroids. |
| Classic presentation | Subacute onset of bilateral shoulder and hip girdle aching and stiffness; Morning stiffness >45 minutes (often hours); Difficulty rising from a chair or lifting arms above the head; Constitutional symptoms in 30-50%: fatigue, low-grade fever, anorexia, weight loss; No true muscle weakness once pain is controlled; Restricted active… | New persistent unilateral temporal or occipital headache; Scalp tenderness (painful to comb hair or wear glasses); Jaw claudication — fatigue or pain in masseter with chewing (highly specific); Tongue claudication (rare but specific); Visual symptoms: amaurosis fugax, diplopia, sudden monocular vision loss; Constitutional: fever,… |
| Workup / key labs | 2012 EULAR/ACR provisional criteria: age ≥50, bilateral shoulder pain, abnormal CRP or ESR, plus weighted morning stiffness, hip involvement, absence of other joint pain, and absence of RF/anti-CCP.; ESR — characteristically >40 mm/h (often >50-100); CRP elevated and may be more sensitive; CBC — normochromic normocytic anemia,… | ACR/EULAR 2022 classification criteria use weighted clinical, laboratory, imaging, and biopsy features in patients ≥50 with suspected medium- or large-vessel vasculitis.; ESR — characteristically >50 mm/h (often >100); CRP elevated and often more sensitive; CBC — normochromic anemia, thrombocytosis; LFTs — mild alkaline phosphatase… |
| Imaging | Shoulder ultrasound or MRI — subacromial-subdeltoid bursitis, biceps tenosynovitis, glenohumeral synovitis (supportive but not required); Temporal artery ultrasound or biopsy if GCA features develop; PET-CT in atypical cases — can show large-vessel uptake | Temporal artery biopsy — gold standard; ≥1 cm specimen; can be performed up to 2 weeks after starting steroids; skip lesions mean a contralateral biopsy may be needed if first negative and suspicion high; Temporal artery ultrasound — 'halo sign' (hypoechoic wall edema), increasingly used as first-line in expert centers; MRA, CTA, or… |
| First-line treatment | Prednisone 12.5-25 mg/day — dramatic improvement within 48-72 hours is both therapeutic and diagnostic; Slow taper over 1-2 years guided by symptoms and inflammatory markers (typical schedule: reduce by 2.5 mg every 2-4 weeks until 10 mg, then 1 mg every 1-2 months); Bone-protective therapy: calcium 1000-1200 mg/day, vitamin D 800-2000… | Do not wait for biopsy — start glucocorticoids immediately when GCA is clinically suspected; Prednisone 40-60 mg/day if no visual symptoms; IV methylprednisolone 500-1000 mg daily for 3 days then high-dose oral prednisone if visual symptoms or recent vision loss; Slow taper over 12-24 months guided by symptoms and ESR/CRP; Low-dose… |
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