Polymyalgia Rheumatica and Giant Cell Arteritis: A Systematic Review

Area of Science:

• Rheumatology
• Internal Medicine
• Diagnostic Imaging

Background:

• Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are common inflammatory conditions in individuals over 50.
• Current diagnostic and treatment strategies for PMR and GCA are inconsistent in clinical practice.

Purpose of the Study:

• To review and synthesize current evidence on the optimal diagnostic and therapeutic approaches for PMR and GCA.

Main Methods:

• A comprehensive literature search of MEDLINE, EMBASE, and Cochrane databases was conducted.
• Fifty articles were selected based on inclusion criteria, with study quality assessed using QUADAS-2 or AHA/ACC methodology.
• Included studies comprised 20 randomized clinical trials for therapy and 30 imaging studies for diagnosis and treatment response.

Main Results:

• PMR diagnosis involves shoulder pain, stiffness, and functional impairment; GCA is characterized by headache and visual disturbances. Both conditions often present with constitutional symptoms and elevated inflammatory markers.
• Ultrasound can detect subdeltoid bursitis in PMR. Temporal artery biopsy is standard for GCA, though ultrasound and MRI showing inflammation can support diagnosis.
• Glucocorticoids are the mainstay treatment for both PMR and GCA. Methotrexate may reduce steroid dosage and relapses, while tocilizumab has shown promise in increasing GCA remission rates.

Conclusions:

• Diagnosis of PMR/GCA integrates clinical features and inflammatory markers, with imaging aiding accuracy.
• Temporal artery biopsy may be unnecessary for GCA if typical clinical and imaging findings are present.
• Glucocorticoids are effective, with methotrexate as a potential steroid-sparing agent for patients at risk of relapse or experiencing adverse effects.