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Diagnosing and treating giant cell arteritis (GCA)

Back to Hip and shoulder pain in older adults – PMR

Perhaps 510% of patients with PMR are also diagnosed with giant cell arteritis (GCA). In some cases the GCA only appears later.

Untreated GCA can result in permanent visual loss or stroke, so it's a 'must not miss' diagnosis.

Symptoms of GCA

Ask patients with PMR about:

  • headaches (especially abrupt-onset)
  • tenderness of the scalp
  • tenderness or thickening of the temporal arteries
  • pain on chewing (jaw or tongue claudication)
  • visual disturbance.

It's also important to tell your patients to report these symptoms if they develop them between reviews.

Treating GCA

GCA symptoms may need high glucocorticoid doses. For people without visual symptoms the dose for GCA is 40–60 mg/day prednisolone (minimum 0.75 mg/kg) – the risk of steroid-associated side-effects is therefore high.

Urgent referral is required for any patient showing symptoms of GCA – usually to rheumatology or ophthalmology, depending on local pathways).

Advise your patient to seek urgent (same-day) medical attention if they develop any visual disturbances such as:

  • visual loss
  • double vision
  • visual field defects.
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Back to Hip and shoulder pain in older adults – PMR

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