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Essentials of Diagnosis
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Age over 50 years
Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CPR)
Polymyalgia rheumatica: pain and stiffness in shoulders and hips lasting for several weeks without other explanation
Giant cell arteritis: headache, jaw claudication, polymyalgia rheumatica, visual abnormalities; without treatment, permanent blindness may occur
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General Considerations
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POLYMYALGIA RHEUMATICA
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Pain and stiffness of the shoulder and pelvic girdle areas
Fever, malaise, and weight loss
Anemia and a markedly elevated sedimentation rate are almost always present
Muscle pain much greater than muscle weakness
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Headache, scalp tenderness, visual symptoms, jaw claudication, or throat pain
The temporal artery is usually normal on physical examination but may be nodular, enlarged, tender, or pulseless
Blindness
Results from occlusive arteritis of the posterior ciliary branch of the ophthalmic artery
Ischemic optic neuropathy may produce no funduscopic findings for the first 24–48 hours after the onset of blindness
Asymmetry of pulses in the arms, a murmur of aortic regurgitation, or bruits near the clavicle resulting from subclavian artery stenoses identify an affected aorta or its major branches
Forty percent of patients with giant cell arteritis have nonclassic symptoms at presentation, primarily respiratory tract problems (most frequently dry cough), mononeuritis multiplex (most frequently with painful paralysis of a shoulder), or fever of unknown origin
The fever can be as high as 40°C and is frequently associated with rigors and sweats
Unexplained head or neck pain in an older patient may signal the presence of giant cell arteritis
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Differential Diagnosis
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POLYMYALGIA RHEUMATICA
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POLYMYALGIA RHEUMATICA
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