Polymyalgia rheumatica and giant cell arteritis
Girdle stiffness with raised inflammatory markers after 50, the GCA symptoms that make it an emergency, same-day steroids, ultrasound or biopsy, steroid tapers from the 2025 EULAR update, and tocilizumab or upadacitinib to spare steroids.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Both diseases occur almost only after 50 and peak in the 70s, with women affected two to three times as often as men. They overlap: polymyalgia symptoms occur in up to half of people with GCA, and around 1 in 5 people with PMR has GCA on biopsy or imaging.
- PMR is aching and stiffness of the shoulder and hip girdles with raised inflammatory markers and a dramatic response to moderate-dose prednisolone.
- GCA is a granulomatous vasculitis of large and medium arteries. Untreated, it blinds. Start high-dose prednisolone the same day on clinical suspicion, then confirm with ultrasound or biopsy.
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Sources
- Therapeutic Guidelines: Rheumatology (polymyalgia rheumatica and giant cell arteritis)AU/NZTherapeutic Guidelines Limited (eTG complete), current online version, accessed November 2026
- Services Australia: giant cell arteritis PBS authority requirementsAU/NZServices Australia, accessed November 2026
- Pharmaceutical Benefits Scheme: tocilizumab for active giant cell arteritis, item 11744D restrictionAU/NZAustralian Government Department of Health, Disability and Ageing, online schedule, accessed 13 November 2026
- Mukhtyar CB et al. 2025 EULAR recommendations for the management of polymyalgia rheumatica and primary large vessel vasculitis. Ann Rheum Dis 2026EULAR, 2025 (published 2026)
- Mackie SL et al. British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis. Rheumatology 2020;59:e1-e23British Society for Rheumatology, 2020
- Dejaco C et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update. Ann Rheum Dis 2024;83:741-51EULAR, 2023 update
- Maz M et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis. Arthritis Care Res 2021;73:1071-87American College of Rheumatology, 2021
- Ponte C et al. 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis. Ann Rheum Dis 2022;81:1647-53ACR and EULAR, 2022
- Dasgupta B et al. 2012 provisional classification criteria for polymyalgia rheumatica: a EULAR/ACR collaborative initiative. Ann Rheum Dis 2012;71:484-92EULAR and ACR, 2012
- Stone JH et al. Trial of tocilizumab in giant-cell arteritis (GiACTA). N Engl J Med 2017;377:317-28New England Journal of Medicine, 2017
- Blockmans D et al. A phase 3 trial of upadacitinib for giant-cell arteritis (SELECT-GCA). N Engl J Med 2025;392:2013-24New England Journal of Medicine, 2025
- Last updated
- 14 November 2026
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