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Our rapid access diagnostic care pathways allow early referral of patients who appear to have PMR or GCA, before glucocorticoids are prescribed. Using set referral criteria, we identify patients with PMR who can follow our slow-reduction glucocorticoid regimen without recurrence or exacerbation in about 80% of cases, a much lower relapse rate than that reported using more rapid reduction regimens. We have a low threshold for performing a temporal artery biopsy in GCA and where possible defer treatment until this is done. Using this approach, we can establish a secure diagnosis in the vast majority of patients and refer them back to primary care for our standardised treatment regimens.<\/jats:p>","DOI":"10.4997\/jrcpe.2012.413","type":"journal-article","created":{"date-parts":[[2012,12,14]],"date-time":"2012-12-14T05:24:23Z","timestamp":1355462663000},"page":"341-349","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Our approach to the diagnosis and treatment of polymyalgia rheumatica and giant cell (temporal) arteritis"],"prefix":"10.1177","volume":"42","author":[{"given":"V","family":"Quick","sequence":"first","affiliation":[{"name":"Rheumatology Specialist Registrar, Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JR","family":"Kirwan","sequence":"additional","affiliation":[{"name":"Professor of Rheumatic Diseases, Visiting Professor, University of the West of England, Consultant Rheumatologist, University Hospitals Bristol NHS Foundation Trust, University of Bristol Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2012,12,1]]},"reference":[{"key":"bibr1-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"1 Smeeth L, Cook C, Incidence of diagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom Hall AJ., 1990\u2013 2001. Ann Rheum Dis 2006; 65:1093\u20138. http:\/\/dx.doi.org\/10.1136\/ard.2005.046912","DOI":"10.1136\/ard.2005.046912"},{"key":"bibr2-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"2 Salvarani C, Cantini F, Hunder G. Polymyalgia rheumatica and giant cell arteritis. Lancet 2008; 372:234\u201345. http:\/\/dx.doi.org\/10.1016\/S0140-6736(08)61077-6","DOI":"10.1016\/S0140-6736(08)61077-6"},{"key":"bibr3-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"3 Soriano A, Landolfi R, Manna R. Polymyalgia rheumatic in 2011. Best Pract Res Clin Rheumatol 2012; 26:91\u2013104. http:\/\/dx.doi.org\/10.1016\/j.berh.2012.01.007","DOI":"10.1016\/j.berh.2012.01.007"},{"key":"bibr4-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(14)70123-0"},{"key":"bibr5-JRCPE.2012.413","first-page":"316","volume":"29","author":"Kirwan JR.","year":"1990","journal-title":"Treatment of polymyalgia rheumatica"},{"key":"bibr6-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"6 Dasgupta B, Borg FA, Hassan N  BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology 2010; 49:186\u201390. http:\/\/dx.doi.org\/10.1093\/rheumatology\/kep303a","DOI":"10.1093\/rheumatology\/kep303a"},{"key":"bibr7-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"7 Dasgupta B, Borg FA, Hassan N  BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology 2010; 49:1594\u20137. http:\/\/dx.doi.org\/10.1093\/rheumatology\/keq039a","DOI":"10.1093\/rheumatology\/keq039a"},{"key":"bibr8-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"8 Kirwan J, Hosie G. Management policies for polymyalgia rheumatica. Br J Rheumatol 1994; 30:690\u20131. http:\/\/dx.doi.org\/10.1093\/rheumatology\/33.7.690-a","DOI":"10.1093\/rheumatology\/33.7.690-a"},{"key":"bibr9-JRCPE.2012.413","first-page":"143","volume":"31","author":"Hosie G","year":"1992","journal-title":"Br J Rheumatol"},{"key":"bibr10-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.1136\/ard.60.11.1021"},{"key":"bibr11-JRCPE.2012.413","first-page":"2179","volume":"27","author":"Gonzalez-Gay MA","year":"2000","journal-title":"J Rheumatol"},{"key":"bibr12-JRCPE.2012.413","first-page":"518","volume":"55","author":"Dasgupta B","year":"2006","journal-title":"Polymyalgia rheumatica: the mess we are now in and what we need to do about it"},{"key":"bibr13-JRCPE.2012.413","first-page":"249","volume":"6","author":"Matteson EL.","year":"2010","journal-title":"Clinical guidelines: unravelling the tautology of polymyalgia"},{"key":"bibr14-JRCPE.2012.413","first-page":"1945","volume":"26","author":"Narvaez J","year":"1999","journal-title":"J Rheumatol"},{"key":"bibr15-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"15 Gran JT, Myklebust G. The incidence and clinical characteristics of peripheral arthritis in polymyalgia rheumatica and temporal arteritis: a prospective study of 231 cases. Rheumatology 2000; 39:283\u20137. http:\/\/dx.doi.org\/10.1093\/rheumatology\/39.3.283","DOI":"10.1093\/rheumatology\/39.3.283"},{"key":"bibr16-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"16 Pease CT, Haugeberg G, Montague B  Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study. Rheumatology 2009; 48:123\u20137. http:\/\/dx.doi.org\/10.1093\/rheumatology\/ken343","DOI":"10.1093\/rheumatology\/ken343"},{"key":"bibr17-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"17 Cutolo M, Montecucco CM, Cavagna L  Serum cytokines and steroidal hormones in polymyalgia rheumatica and elderly-onset rheumatoid arthritis. Ann Rheum Dis 2006; 65:1438\u201343. http:\/\/dx.doi.org\/10.1136\/ard.2006.051979","DOI":"10.1136\/ard.2006.051979"},{"key":"bibr18-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"18 Salvarani C, Cantini F, Macchioni P  Distal musculoskeletal manifestations in polymyalgia rheumatica: a prospective follow up study. Arthritis Rheum 1998; 41:1221\u20136. http:\/\/dx.doi.org\/10.1002\/1529-0131(199807)41:7<1221:AID-ART12>3.0.CO;2-W","DOI":"10.1002\/1529-0131(199807)41:7<1221::AID-ART12>3.0.CO;2-W"},{"key":"bibr19-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"19 Dasgupta B, Cimmino MA, Maradit-Kremers H  2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism\/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2012; 71:484\u201392. http:\/\/dx.doi.org\/10.1136\/annrheumdis-2011-200329","DOI":"10.1016\/j.ymed.2012.09.009"},{"key":"bibr20-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"20 Bird HA, Esselinckx W, Dixon AS  An evaluation of criteria for polymyalgia. Ann Rheum Dis 1979; 38:434\u20139. http:\/\/dx.doi.org\/10.1136\/ard.38.5.434","DOI":"10.1136\/ard.38.5.434"},{"key":"bibr21-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"21 Jones JG, Prognosis Hazleman BL., of management polymyalgia rheumatica. Ann Rheum Dis 1981; 40:1\u20135. http:\/\/dx.doi.org\/10.1136\/ard.40.1.1","DOI":"10.1136\/ard.40.1.1"},{"key":"bibr22-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-97-5-672"},{"key":"bibr23-JRCPE.2012.413","first-page":"322","volume":"13","author":"Healey LA.","year":"1984","journal-title":"Long-term follow-up of polymyalgia rheumatica: evidence for synovitis"},{"key":"bibr24-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"24 Cantini F, Salvarani C, Olivier I  Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatica: a prospective follow-up study. Semin Arthritis Rheum 2000; 30:17\u201324. http:\/\/dx.doi.org\/10.1053\/sarh.2000.8366","DOI":"10.1053\/sarh.2000.8366"},{"key":"bibr25-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"25 Ellis ME, Ralston S. The ESR in the diagnosis and management of the polymyalgia rheumatica\/giant cell arteritis syndrome. Ann Rheum Dis 1983; 42:168\u201370. http:\/\/dx.doi.org\/10.1136\/ard.42.2.168","DOI":"10.1136\/ard.42.2.168"},{"key":"bibr26-JRCPE.2012.413","first-page":"270","volume":"6","author":"Reilly PA","year":"1987","journal-title":"Giant cell arteritis precipitated by a diagnostic trial of prednisolone in suspected polymyalgia rheumatica"},{"key":"bibr27-JRCPE.2012.413","first-page":"I67","volume":"49","author":"Zacout S","year":"2010","journal-title":"Rheumatology"},{"key":"bibr28-JRCPE.2012.413","first-page":"395","volume":"26","author":"Cimmino MA","year":"2008","journal-title":"Clin Exp Rheumatol"},{"key":"bibr29-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"29De Silva M, Hazleman BL. Azathioprine in giant cell arteritis\/polymyalgia rheumatica: a double-blind study. Ann Rheum Dis 1986; 45:136\u20138. http:\/\/dx.doi.org\/10.1136\/ard.45.2.136","DOI":"10.1136\/ard.45.2.136"},{"key":"bibr30-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-9-200705010-00005"},{"key":"bibr31-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.1186\/ar3140"},{"key":"bibr32-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"32 Hernandez-Rodriguez J, Cid MC, Lopez-Soto A  Treatment of polymyalgia rheumatica: a systematic review. Arch Intern Med 2009; 169:1839\u201350. http:\/\/dx.doi.org\/10.1001\/archinternmed.2009.352","DOI":"10.1001\/archinternmed.2009.352"},{"key":"bibr33-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-12-94"},{"key":"bibr34-JRCPE.2012.413","unstructured":"34 Salvarani C, Macchioni PL, Tartoni PL  Polymyalgia rheumatica and giant cell arteritis: a 5-year epidemiologic and clinical study in Reggio Emilia, Italy. Clin Exp Rheumatol 1987: 5:205\u201315."},{"key":"bibr35-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"35 Delecoeuillerie D, Joly P, Cohen de\u00a0Lara A  Polymyalgia rheumatica and temporal arteritis: a retrospective analysis of prognostic features and different corticosteroid regimens (11 year survey of 210 patients). Ann Rheum Dis 1988; 47:733\u20139. http:\/\/dx.doi.org\/10.1136\/ard.47.9.733","DOI":"10.1136\/ard.47.9.733"},{"key":"bibr36-JRCPE.2012.413","first-page":"1340","volume":"17","author":"Lundberg I","year":"1990","journal-title":"J Rheumatol"},{"key":"bibr37-JRCPE.2012.413","first-page":"344","volume":"300","author":"Kyle V","year":"1990","journal-title":"Stopping steroids in polymyalgia rheumatica and giant cell arteritis"},{"key":"bibr38-JRCPE.2012.413","first-page":"260","volume":"30","author":"Myklebust G","year":"2001","journal-title":"Prednisolone maintenance dose in relation to starting dose in the treatment of polymyalgia rheumatica and temporal arteritis. A prospective two-year study in 273 patients"},{"key":"bibr39-JRCPE.2012.413","first-page":"1326","volume":"26","author":"Gonzalez-Gay MA","year":"1999","journal-title":"J Rheumatol"},{"key":"bibr40-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"40 Behn AR, Perera T, Myles AB. Polymyalgia rheumatica and corticosteroids: how much for how long? Ann Rheum Dis 1983; 42:374\u20138. http:\/\/dx.doi.org\/10.1136\/ard.42.4.374","DOI":"10.1136\/ard.42.4.374"},{"key":"bibr41-JRCPE.2012.413","first-page":"658","volume":"48","author":"Kyle V","year":"1989","journal-title":"Treatment of polymyalgia rheumatica and giant cell arteritis. I. Steroid regimes in the first two months"},{"key":"bibr42-JRCPE.2012.413","first-page":"847","volume":"52","author":"Kyle V","year":"1993","journal-title":"The clinical and laboratory course of polymyalgia rheumatica\/giant cell arteritis after the first two months of treatment"},{"key":"bibr43-JRCPE.2012.413","first-page":"65","volume":"32","author":"Kremers HM","year":"2005","journal-title":"J Rheumatol"},{"key":"bibr44-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"44 Hutchings A, Hollywood J, Lamping DL at al. Clinical outcomes, quality of life and diagnostic uncertainty in the first year of polymyalgia rheumatica. Arthritis Rheum 2007; 57:803\u20139. http:\/\/dx.doi.org\/10.1002\/art.22777","DOI":"10.1002\/art.22777"},{"key":"bibr45-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"45 Dasgupta B, Dolan AL, Panayi GS  An initially double-blind controlled 96 week trial of depot methylprednisolone against oral prednisolone in the treatment of polymyalgia rheumatica. Br J Rheumatol 1998; 37:189\u201395. http:\/\/dx.doi.org\/10.1093\/rheumatology\/37.2.189","DOI":"10.1093\/rheumatology\/37.2.189"},{"key":"bibr46-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-141-7-200410050-00005"},{"key":"bibr47-JRCPE.2012.413","first-page":"65","volume":"31","author":"Roy M","year":"2012","journal-title":"CML Rheumatology"},{"key":"bibr48-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21712"},{"key":"bibr49-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"49 Maradit-Kremers H, Reinalda MS, Crowson CS  Glucocorticoids and cardiovascular and cerebrovascular events in polymyalgia rheumatica. Arthritis Rheum 2007; 57:279\u201386. http:\/\/dx.doi.org\/10.1002\/art.22548","DOI":"10.1002\/art.22548"},{"key":"bibr50-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"50 Gabriel SE, Sunku J, Salvarani C  Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. 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Available from: http:\/\/summaries.cochrane.org\/CD001347."},{"key":"bibr54-JRCPE.2012.413","first-page":"432","volume":"70","author":"Zacout S","year":"2011","journal-title":"Ann Rheum Dis"},{"key":"bibr55-JRCPE.2012.413","first-page":"138","volume":"12","author":"Kermani TA","year":"2012","journal-title":"Recent advances in diagnostic strategies for giant cell arteritis"},{"key":"bibr56-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"56 Hunder GG, Bloch DA, Michel BA  The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990; 33:1122\u20138. http:\/\/dx.doi.org\/10.1002\/art.1780330810","DOI":"10.1002\/art.1780330810"},{"key":"bibr57-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-129-5-199809010-00001"},{"key":"bibr58-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"58 Younge BR, Cook BE, Bartley GB  Initiation of glucocorticoid therapy: before or after temporal artery biopsy? Mayo Clin Proc 2004; 79:483\u201391. http:\/\/dx.doi.org\/10.4065\/79.4.483","DOI":"10.4065\/79.4.483"},{"key":"bibr59-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.1186\/ar2003"},{"key":"bibr60-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"60 Mukhtyar C, Guillevin L, Cid MC  EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2009; 68:318\u201323. http:\/\/dx.doi.org\/10.1136\/ard.2008.088351","DOI":"10.1136\/ard.2008.088351"},{"key":"bibr61-JRCPE.2012.413","first-page":"416","volume":"43","author":"Allison MC","year":"1984","journal-title":"Temporal artery biopsy and corticosteroid treatment"},{"key":"bibr62-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-120-12-199406150-00003"},{"key":"bibr63-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"63 Ray-Chaudhuri N, Kine DA, Tijani SO  Effect of prior steroid treatment on temporal artery biopsy findings in giant cell arteritis. Br J Ophthamol 2002; 86:530\u20132. http:\/\/dx.doi.org\/10.1136\/bjo.86.5.530","DOI":"10.1136\/bjo.86.5.530"},{"key":"bibr64-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"64 Smetana GW, Shmerling RH. Does this patient have temporal arteritis? JAMA 2002; 287:92\u2013101. http:\/\/dx.doi.org\/10.1001\/jama.287.1.92","DOI":"10.1001\/jama.287.1.92"},{"key":"bibr65-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"65 Mahr AD, Jover JA, Spiera RF  Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data metaanalysis. Arthritis Rheum 2007; 56:2789\u201397. http:\/\/dx.doi.org\/10.1002\/art.22754","DOI":"10.1002\/art.22754"},{"key":"bibr66-JRCPE.2012.413","first-page":"219","volume":"79","author":"Masson C.","year":"2012","journal-title":"Therapeutic approach to giant cell arteritis"},{"key":"bibr67-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-9-200705010-00004"},{"key":"bibr68-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"68 Proven A, Gabriel SE, Orces C  Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Rheum 2003; 49:703\u20138. http:\/\/dx.doi.org\/10.1002\/art.11388","DOI":"10.1002\/art.11388"},{"key":"bibr69-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"69 Zacout S, Kirwan JR. Polymyalgia rheumatica has a nocturnal rise in interleukin-6 which is almost completely supressed by night time prednisolone. Arthritis Rheum 2011; 63:S27.","DOI":"10.1136\/annrheumdis-2012-eular.103"},{"key":"bibr70-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"70 Vinit J, Bielefeld P, Muller G  Efficacy of tocilizumab in refractory giant cell arteritis. Joint Bone Spine 2012; 79:317\u20138. http:\/\/dx.doi.org\/10.1016\/j.jbspin.2011.11.008","DOI":"10.1016\/j.jbspin.2011.11.008"},{"key":"bibr71-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.4414\/smw.2011.13156"},{"key":"bibr72-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"72 Sciascia S, Rossi D, Roccatello D. Interleukin 6 blockade as steroidsparing treatment for 2 patients with giant cell arteritis. J Rheumatol 2011; 38:2080\u20131. http:\/\/dx.doi.org\/10.3899\/jrheum.110496","DOI":"10.3899\/jrheum.110496"},{"key":"bibr73-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"73 Beyer C, Axmann R, Sahinbegovic E  Anti-interleukin 6 receptor therapy as rescue treatment for giant cell arteritis. Ann Rheum Dis 2011; 70:1874\u20135. http:\/\/dx.doi.org\/10.1136\/ard.2010.149351","DOI":"10.1136\/ard.2010.149351"},{"key":"bibr74-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-142-5-200503010-00011"},{"key":"bibr75-JRCPE.2012.413","doi-asserted-by":"crossref","unstructured":"75 Ball EL, Walsh SR, Tang TY  Role of ultrasonography in the diagnosis of temporal arteritis. Br J Surg 2010; 97:1765\u201371. http:\/\/dx.doi.org\/10.1002\/bjs.7252","DOI":"10.1002\/bjs.7252"},{"key":"bibr76-JRCPE.2012.413","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-11-44"}],"container-title":["Journal of the Royal College of Physicians of Edinburgh"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4997\/JRCPE.2012.413","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4997\/JRCPE.2012.413","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:26:02Z","timestamp":1777616762000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.4997\/JRCPE.2012.413"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,12]]},"references-count":76,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2012,12]]}},"alternative-id":["10.4997\/JRCPE.2012.413"],"URL":"https:\/\/doi.org\/10.4997\/jrcpe.2012.413","relation":{},"ISSN":["1478-2715","2042-8189"],"issn-type":[{"value":"1478-2715","type":"print"},{"value":"2042-8189","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,12]]}}}