Questions and Answers about Polymyalgia Rheumatica and Giant Cell Arteritis
How Are Polymyalgia Rheumatica and Giant Cell Arteritis Diagnosed? continued...
Before making a diagnosis of polymyalgia rheumatica, the doctor may order additional tests. For example, the C-reactive protein test is another common means of measuring inflammation. There is also a common test for rheumatoid factor, an antibody (a protein made by the immune system) that is sometimes found in the blood of people with rheumatoid arthritis. While polymyalgia rheumatica and rheumatoid arthritis share many symptoms, those with polymyalgia rheumatica rarely test positive for rheumatoid factor. Therefore, a positive rheumatoid factor might suggest a diagnosis of rheumatoid arthritis instead of polymyalgia rheumatica.
As with polymyalgia rheumatica, a diagnosis of giant cell arteritis is based largely on symptoms and a physical examination. The exam may reveal that the temporal artery is inflamed and tender to the touch, and that it has a reduced pulse.
Any doctor who suspects giant cell arteritis should order a temporal artery biopsy. In this procedure, a small section of the artery is removed through an incision in the skin over the temple area and examined under a microscope. A biopsy that is positive for giant cell arteritis will show abnormal cells in the artery walls. Some patients showing symptoms of giant cell arteritis will have negative biopsy results. In such cases, the doctor may suggest a second biopsy.
How Are They Treated?
The treatment of choice for both polymyalgia rheumatica and giant cell arteritis is corticosteroid medication, usually prednisone.
Polymyalgia rheumatica responds to a low daily dose of prednisone that is increased as needed until symptoms disappear. At this point, the doctor may gradually reduce the dosage to determine the lowest amount needed to alleviate symptoms. Most patients can discontinue medication after 6 months to 2 years. If symptoms recur, prednisone treatment is required again.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin*), also may be used to treat polymyalgia rheumatica. The medication must be taken daily, and long-term use may cause stomach irritation. For most patients, NSAIDs alone are not enough to relieve symptoms.
Even without treatment, polymyalgia rheumatica usually disappears in 1 to several years. With treatment, however, symptoms disappear quickly, usually in 24 to 48 hours. If prednisone doesn’t bring improvement, the doctor is likely to consider other possible diagnoses.