Clinical Manifestations

The onset of GCA and PMR symptoms is usually gradual, although in some patients, the disease presents abruptly (1,3). Systemic symptoms including fever, fatigue, and weight loss occur in approximately half of the patients, and in some patients, the fever may be as high as 40°C. Patients with PMR have bilateral proximal limb discomfort, which may restrict movement. Typically, about one-third of patients will have systemic manifestations. Some patients with PMR develop a peripheral arthritis, especially of the knees and wrists, and also may develop pitting edema of the dorsum of the hands, feet, and ankles (5).

Like PMR, the onset of GCA is usually gradual. About 50% of patients have systemic features including fever. Two-thirds of patients complain of headache, which may be located over the temporal, parietal, or occipital area but may be more diffuse. Scalp tenderness often accompanies the headache. At presentation, about 25% of patients have symptoms of PMR, and about 15% of patients have fevers, while one-third of patients will have headache as the initial presenting feature (1,3,5). Larger artery involvement in GCA occurs in approximately 15% of patients.

Early manifestations of larger artery involvement can include arm, or less frequently, leg claudication with absent or markedly diminished extremity pulses. Aortic aneurysms are 17 times more frequent in patients with GCA than nonaffected controls, with an incidence of approximately 15% (1,3). Large artery stenosis frequently presents within the first year of disease, while aneurysms are a late complication occurring after a mean of approximately five years of disease (6). Tables 1 and 2 contain a summary of the frequency of GCA-related symptoms on presentation and their prevalence.

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