DIAGNOSIS, TREATMENT, & STEPS TO TAKE

Diagnosis of Polymyalgia Rheumatica and Giant Cell Arteritis

There is no single test to tell if you have polymyalgia rheumatica or giant cell arteritis. The doctor usually:

  • Takes your medical history and performs a physical exam. He or she will likely examine the temporal arteries for evidence of swelling or tenderness, signs of giant cell arteritis.
  • Orders blood tests, such as the erythrocyte sedimentation rate (ESR or “sed” rate) and C-reactive protein (CRP) test. These tests are measures of inflammation, but they are not specific for polymyalgia rheumatica or giant cell arteritis. They can indicate any inflammatory disorder.

The doctor may also:

  • Obtain a biopsy of the temporal artery if giant cell arteritis is suspected. The procedure is performed using local anesthetic. A pathologist will examine the sample under a microscope and look for signs of inflammation.
  • Order imaging tests. An ultrasound, positron emission tomography (PET), computed tomography (CT), or magnetic resonance imaging (MRI) scan can reveal changes consistent with the disorders, such as swelling and inflammation in large vessels, or may help rule out other diseases and conditions.
  • Request consultation from specialists such as an ophthalmologist if concerning visual symptoms are occurring.

Treatment of Polymyalgia Rheumatica and Giant Cell Arteritis

The primary goal of treatment for polymyalgia rheumatica is relief of symptoms. For giant cell arteritis, the aim is to alleviate symptoms and to prevent vision loss and other potential complications.

Polymyalgia rheumatica and giant cell arteritis are primarily treated with:

  • Corticosteroids. These anti-inflammatory medications are a mainstay of treatment for both disorders. Doctors usually prescribe low to moderate doses, taken orally, for polymyalgia rheumatica and higher doses for giant cell arteritis. Most people respond to these medications within days to weeks, and once symptoms resolve, the dosage is usually gradually decreased. You may remain on a maintenance dose for a year or possibly longer. Because these are potent drugs, your doctor will prescribe the lowest dose possible to achieve the desired benefit. 

Other medications your doctor may prescribe include:

  • Disease-modifying antirheumatic drugs (DMARDs). These medications, approved for other conditions, are small molecules that act on inflammation at the cellular level. Doctors may prescribe them in combination with corticosteroids, especially in people who experience side effects from these medications, or to quell a flare of symptoms.
  • Biologic response modifiers. These medications, which are also DMARDs, target specific immune messages and interrupt the signal, helping to decrease or stop inflammation. They are sometimes prescribed in combination with corticosteroids, in people with giant cell arteritis.

Osteoporosis, a condition characterized by weak and brittle bones, can be a complication of taking corticosteroids, so your doctor may also prescribe medications to strengthen the bones.

Who Treats Polymyalgia Rheumatica and Giant Cell Arteritis?

Polymyalgia rheumatica and giant cell arteritis are primarily treated by:

  • Rheumatologists, who specialize in treating arthritis and other diseases that affect the joints, bones, muscles, and immune system.
  • Primary care doctors, such as family physicians or internal medicine specialists.

Other health care providers who may be involved in your care include:

  • Ophthalmologists, in cases of giant cell arteritis in which the eyes are affected. Ophthalmologists specialize in treating disorders and diseases of the eye. 
  • Cardiologists or vascular surgeons, in cases of giant cell arteritis affecting the aorta and its main branches. These specialists focus on treating blood vessel problems. 
  • Mental health professionals, who help people cope with difficulties in the home and workplace that may result from their medical conditions. 
  • Physical therapists, movement specialists who improve quality of life through prescribed exercise, hands-on care, and patient education.

Living With Polymyalgia Rheumatica and Giant Cell Arteritis

Corticosteroids can cause side effects, even at low doses, and it is important to let your doctor know if you experience any of them. The side effects include:

  • Heightened risk of infections.
  • Mood swings.
  • Insomnia.
  • High blood pressure.
  • Vision problems (such as cataracts or glaucoma).
  • Diabetes.
  • Osteoporosis (thinning, weakened bones).
  • Weight gain.
  • Swelling of face, legs, or other parts of the body.
  • Loss of muscle.

If you notice signs of any of these adverse effects, your doctor may need to adjust the corticosteroid dose. Below are some tips to help you avoid side effects.

  • To protect your bones, make sure you get enough calcium and vitamin D and do weight-bearing exercises, such as walking.
  • To avoid weight gain and lower the risk of diabetes and high blood pressure, eat a healthy balanced diet and exercise regularly.
  • If you smoke, see your doctor about making a plan to quit. Smoking can affect bone and heart health.

It is also important to:

  • Visit your health care providers regularly and follow their recommendations.
  • Talk to your doctor before beginning an exercise program. He or she may refer you to a physical therapist, who can develop a plan to help you be more active and manage pain.
  • Talk to a mental health professional or join a support group if you develop anxiety or depression. Living with polymyalgia rheumatica or giant cell arteritis may be challenging at times, and sharing your experiences with others may help.