Polymyalgia Rheumatica and Giant Cell Arteritis: A Geriatric Perspective

Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are inflammatory disorders predominantly affecting older adults. PMR is primarily characterized by proximal muscle pain and systemic inflammation, while GCA involves large-vessel inflammation, posing risks of vision loss and stroke. Due to overlapping clinical features and age-related prevalence, diagnosing these conditions remains challenging. While PMR is largely diagnosed based on clinical symptoms and laboratory markers, GCA often requires histopathological confirmation via temporal artery biopsy (TAB). This study aims to assess the clinical presentation, diagnostic approaches, and treatment outcomes of PMR and GCA in geriatric patients, emphasizing the role of clinical versus laboratory and histopathological diagnosis.

A cross-sectional study was conducted at Khyber Teaching Hospital, Peshawar, Pakistan, from September 2023 to September 2024, involving 118 patients aged 50 years or older diagnosed with PMR and/or GCA. Data were collected through patient interviews, medical records, and diagnostic reports. Statistical analyses were performed to evaluate clinical characteristics, laboratory markers, and treatment responses.

The mean age of participants was 68.5 ± 7.4 years, with 65% female. PMR diagnosis was based on clinical symptoms, supported by laboratory markers such as elevated CRP (85%) and ESR (90%). GCA was clinically suspected in 38 patients, with 76% confirmed through TAB. Additionally, 67% of GCA patients exhibited the "halo sign" on vascular ultrasound, while 12% required magnetic resonance angiography for further evaluation. Glucocorticoid therapy was initiated in all cases, leading to clinical remission in 84% of patients. However, 28% developed hyperglycemia, and 14% experienced osteoporosis as treatment-related complications. Delayed glucocorticoid initiation caused a significantly higher relapse rate (p = 0.04).

Glucocorticoid therapy remains effective in most cases, though adverse effects necessitate careful monitoring. Tocilizumab was required in 18% of patients due to glucocorticoid resistance or intolerance, but it caused higher relapse rates and metabolic complications. The findings emphasize the need for steroid-sparing therapies and personalized treatment approaches to improve long-term disease control. Future research should explore newer biologic treatments, optimize imaging strategies, and address resource limitations to enhance early detection and management outcomes in elderly patients.