Polymyalgia rheumatica and temporal arteritis: managing older patients

PMR and GCA are diagnosed relatively frequently in the white geriatric population. Patients may suffer from both conditions or from either alone. PMR is considered a diagnosis of exclusion, with the most characteristic symptoms being profound morning stiffness affecting the hip and shoulder girdles. The diagnosis of PMR can be buttressed by the findings of an elevated ESR, anemia, and mildly elevated liver enzymes. PMR can be controlled with less than or equal to 20 mg/d of prednisone, whereas higher doses of glucocorticoids are required for GCA. Classic GCA is characterized by headache, visual changes, and constitutional symptoms. GCA can be confirmed by a biopsy revealing a histologic picture of granulomatous inflammation centered around the elastin of the involved vessel. Judicious efforts to taper steroids are indicated in both syndromes, but many patients require therapy for at least 2 years.