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Diagnosis and management of giant cell arteritis and polymyalgia rheumatica: challenges, controversies and practical tips
  1. Sarah Louise Mackie1,
  2. Colin Thomas Pease2
  1. 1Division of Rheumatic and Musculoskeletal Disease, NIHR-Leeds Musculoskeletal Research Unit, Chapel Allerton Hospital, University of Leeds, Leeds, UK
  2. 2Department of Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Dr Sarah Louise Mackie, Division of Rheumatic and Musculoskeletal Disease, NIHR-Leeds Musculoskeletal Research Unit, Chapel Allerton Hospital, University of Leeds, Leeds LS7 4SA, UK; s.l.mackie{at}leeds.ac.uk

Abstract

Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are inflammatory rheumatic diseases that may present to a variety of disciplines and specialities. The mainstay of treatment is glucocorticoids (steroids); together PMR and GCA now represent one of the most common reasons for medium-to-high dose, long-term glucocorticoid treatment in primary care. However, adverse effects of glucocorticoids are common in these patients. Management of both diseases involves balancing the symptoms and risks of the disease against the adverse effects and risks of glucocorticoids. The crucial first step in management is to make a firm, well-documented diagnosis, since once glucocorticoids are started they can mask the symptoms of a number of other diseases. Diagnosis however can be challenging and there are still substantial gaps in the evidence for treatment.

  • Rheumatology
  • Geriatric Medicine

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