The management of polymyalgia rheumatica and giant cell arteritis

Polymyalgia rheumatica and giant cell (cranial/temporal) arteritis are common debilitating conditions affecting people nearly always over the age of 55. Although the two syndromes are closely linked their precise relationship is not fully understood. Polymyalgia rheumatica or giant cell arteritis can occur in a ‘pure’ form or clinical features of each may be present in the same patient. Treatment with a systemic corticosteroid has long been considered mandatory in patients with giant cell arteritis in order to prevent serious vascular complications, particularly blindness1. Treatment with corticosteroid is also usual for patients with polymyalgia rheumatica. Many patients remain on steroids for years. What is the basis for current approaches to management? How should steroids be given and eventually stopped?