Polymyalgia rheumatica and giant cell arteritis: An in-depth look at diagnosis and treatment


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Sally Kennedy PhD, APRN, FNP-C, CNE, College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St. MSC 160, Charleston, SC 29425.
Tel: 843-792-0287;
E-mail: kennes@musc.edu


Purpose: To provide an in-depth synthesis of the literature on polymyalgia rheumatic (PMR) and giant cell arteritis (GCA) that will assist the primary care nurse practitioner (NP) in recognizing the variety of symptom presentations, accurately evaluating laboratory data, developing a plan of care that includes current treatment guidelines, and adroitly managing patients for improved outcomes.

Data sources: A thorough search of the literature was conducted including MEDLINE, CIHAHL, and PubMed encompassing the decades from the 1970s to the present.

Conclusions: Because of the varied and vague symptom presentations of PMR and GCA, primary healthcare providers often misdiagnose these pathologies, delaying treatment and relief of suffering. Textbooks descriptions often omit supplemental content necessary to understand the intricacies of the presenting symptoms, diagnostic tests needed for work-up, and specific treatment for these overlapping pathologies.

Implications for practice: Because PMR and GCA often present in the primary care setting, NPs must maintain a high index of suspicion when a patient over 60 years of age presents with vague complaints such as headache, weakness, anorexia, and malaise. Arriving at an accurate diagnosis in a timely fashion will lead to appropriate treatment and minimize patient suffering.