Management of giant cell arteritis and polymyalgia rheumatica

Giant cell arteritis and polymyalgia rheumatica are closely related disorde rs that affect persons more than 50 years of age and cause substantial morb idity. Patients with giant cell arteritis typically have a localized headac he, nonspecific systemic symptoms, temporal artery tenderness and a high er ythrocyte sedimentation rate (ESR), The diagnosis is confirmed by character istic pathologic findings on temporal artery biopsy. Patients wit polymyalg ia rheumatica usually have similar nonspecific systemic symptoms, proximal muscle pain and stiffness, and an elevated ESR. The diagnosis is based on t he clinical findings. Both disorders are treated with corticosteroids: high dosages for giant cell arteritis (prednisone in a dosage of 40 to 60 mg pe r day) and lower dosages for polymyalgia rheumatica (prednisone in a dosage of 10 to 20 mg per day). Symptom relief in response to treatment is rapid and reinforces the diagnosis. After normalization of the ESR, the corticost eroid is tapered, with the patient monitored closely for symptom recurrence . Most patients require corticosteroid therapy for two to three years and e xperience one or more treatment complications.