Clinical features of polymyalgia rheumatica and giant cell arteritis

Nat Rev Rheumatol. 2012 Sep;8(9):509-21. doi: 10.1038/nrrheum.2012.97. Epub 2012 Jul 24.


Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are inflammatory diseases that typically affect white individuals >50 years. Women are affected ∼2-3 times more often than men. PMR and GCA occur together more frequently than expected by chance. The main symptoms of PMR are pain and stiffness in the shoulders, and often in the neck and pelvic girdle. Imaging studies reveal inflammation of joints and bursae of the affected areas. GCA is a large-vessel and medium-vessel arteritis predominantly involving the branches of the aortic arch. The typical clinical manifestations of GCA are new headache, jaw claudication and visual loss. PMR and GCA usually remit within 6 months to 2 years from disease onset. Some patients, however, have a relapsing course and might require long-standing treatment. Diagnosis of PMR and GCA is based on clinical features and elevated levels of inflammatory markers. Temporal artery biopsy remains the gold standard to support the diagnosis of GCA; imaging studies are useful to delineate large-vessel involvement in GCA. Glucocorticoids remain the cornerstone of treatment of both PMR and GCA, but patients with GCA require higher doses. Synthetic immunosuppressive drugs also have a role in disease management, whereas the role of biologic agents is currently unclear.

Publication types

  • Review

MeSH terms

  • Aged, 80 and over
  • Biopsy
  • Comorbidity
  • Female
  • Giant Cell Arteritis / drug therapy
  • Giant Cell Arteritis / epidemiology
  • Giant Cell Arteritis / pathology*
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Middle Aged
  • Polymyalgia Rheumatica / drug therapy
  • Polymyalgia Rheumatica / epidemiology
  • Polymyalgia Rheumatica / pathology*
  • Temporal Arteries / pathology


  • Glucocorticoids
  • Immunosuppressive Agents