Our approach to the diagnosis and treatment of polymyalgia rheumatica and giant cell (temporal) arteritis

Abstract

We believe there is a strong case for formalised collaborative care between GPs and rheumatologists in the management of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), which can be difficult conditions to diagnose and manage. Our rapid access diagnostic care pathways allow early referral of patients who appear to have PMR or GCA, before glucocorticoids are prescribed. Using set referral criteria, we identify patients with PMR who can follow our slow-reduction glucocorticoid regimen without recurrence or exacerbation in about 80% of cases, a much lower relapse rate than that reported using more rapid reduction regimens. We have a low threshold for performing a temporal artery biopsy in GCA and where possible defer treatment until this is done. Using this approach, we can establish a secure diagnosis in the vast majority of patients and refer them back to primary care for our standardised treatment regimens. © 2012 Royal College of Physicians of Edinburgh.