History and exam
Key diagnostic factors
common
headache
polymyalgia rheumatica symptoms
Typically include aching and stiffness in the neck, shoulders, hips, and proximal extremities that worsen after a period of inactivity and with movement. Pain and swelling of the distal joints may occur.[6]
older age
Giant cell arteritis (GCA) almost never develops before age 50, and its incidence rises steadily thereafter with a peak incidence between 70 and 80 years.[1][9][28][29] The American College of Rheumatology (ACR) classification criteria for GCA include a requirement for the patient to be 50 years of age or older (these criteria should only be applied when a diagnosis of medium- or large-vessel vasculitis has been made).[1]
extremity claudication
Pain may occur with repeated use of the upper extremities. Rarely, pain in the lower extremities may occur in patients with large-vessel involvement.[8]
uncommon
jaw claudication
Patients may have pain with chewing that is unilateral or bilateral. The presence of jaw claudication is highly predictive of a positive temporal artery biopsy (likelihood ratio of 4.2).[34] Occasionally, patients have a trismus or muscle spasm-like pain in the jaw.
sudden loss of vision
Up to 30% of patients develop permanent visual loss.[56] More than 10% of patients report pain at the time of visual loss.[57][58][59] Other visual symptoms may include transient loss of vision, diplopia, or changes to color vision.[60] The presence of diplopia is highly predictive of a positive temporal artery biopsy.[34]
arterial tenderness, thickening, or nodularity
Tenderness, thickening, and nodularity of the frontal or parietal branches of the superficial temporal arteries may be present. A prominent or enlarged temporal artery is highly predictive of a positive temporal artery biopsy (likelihood ratio of 4.3).[34] Other vessels, such as the occipital, postauricular, or facial arteries, may be enlarged or tender.
absent temporal artery pulse
May be detected on exam.
abnormal fundoscopy
Fundoscopic exam in a patient with ischemia of the optic nerve may reveal pallor and edema of the optic disk. Disk alterations follow the development of vision loss. Occasionally, cotton-wool spots and small hemorrhages are evident.
Other diagnostic factors
common
systemic symptoms
Symptoms may include low-grade fever, malaise, fatigue, and weight loss.[9]
uncommon
neurologic symptoms
cough, sore throat, hoarseness
May occasionally occur.[9]
bruit on auscultation
Bruits may be heard on auscultation of the carotid, supraclavicular, axillary, or brachial areas in patients with large-vessel involvement.
asymmetric blood pressure
Blood pressure asymmetry may be present.
shoulder tenderness
In patients with coexistent polymyalgia rheumatica, the shoulders may be tender to palpation.
limited active range of movement of shoulders and hips
In those with coexistent polymyalgia rheumatica, active range of motion of the shoulders and hips is limited due to pain, but generally the degree of tenderness is less than what might be expected in view of the severe pain.
wrist and knee swelling
May be observed on exam.
dental pain, tongue pain, or infarction of the tongue
Oral symptoms and signs may be present.
Use of this content is subject to our disclaimer