History and exam

Key diagnostic factors

common

headache

Usually located over the temporal or occipital areas. It may be accompanied by scalp tenderness.[1][53]​​​

polymyalgia rheumatica symptoms

Typically include aching and stiffness in the neck, shoulders, hips, and proximal extremities that worsen after a period of inactivity and with movement. Pain and swelling of the distal joints may occur.[6]

extremity claudication

Pain may occur with repeated use of the upper extremities. Rarely, pain in the lower extremities may occur in patients with large-vessel involvement.[8]

other cranial artery abnormalities

Other vessels, such as the occipital, postauricular, or facial arteries, may be enlarged or tender.

uncommon

loss of vision

Up to 30% of patients develop permanent visual loss.[54]​ More than 10% of patients report pain at the time of visual loss.[55][56][57]​​​​ Other symptoms may include transient loss of vision, diplopia, or changes to color vision.[58]

jaw claudication

Patients may have pain with chewing that is unilateral or bilateral. The presence of jaw claudication is highly predictive of a positive temporal artery biopsy (likelihood ratio of 4.2).[33] Occasionally, patients have a trismus or muscle spasm-like pain in the jaw.

superficial temporal artery tenderness, thickening, or nodularity

Tenderness, thickening, and nodularity of the frontal or parietal branches of the superficial temporal arteries may be present. A prominent or enlarged temporal artery is highly predictive of a positive temporal artery biopsy (likelihood ratio of 4.3).[33]

absent temporal artery pulse

May be detected on examination.

abnormal fundoscopy

Fundoscopic examination in a patient with ischemia of the optic nerve may reveal pallor and edema of the optic disk. Disk alterations follow the development of vision loss. Occasionally, cotton-wool spots and small hemorrhages are evident.

Other diagnostic factors

common

systemic symptoms

Symptoms may include low-grade fever, malaise, fatigue, and weight loss.[9]

uncommon

neurologic symptoms

Include hemiplegia, weakness, dysphasia, dysarthria, and balance difficulties. These symptoms are related to stroke, transient ischemic attack, or neuropathy.[2][3][9]

cough, sore throat, hoarseness

May occasionally occur.[9]

bruit on auscultation

Bruits may be heard on auscultation of the carotid, supraclavicular, axillary, or brachial areas in patients with large-vessel involvement.

asymmetric blood pressure

Blood pressure asymmetry may be present.

shoulder tenderness

In patients with coexistent polymyalgia rheumatica, the shoulders may be tender to palpation.

limited active range of movement of shoulders and hips

In those with coexistent polymyalgia rheumatica, active range of motion of the shoulders and hips is limited due to pain, but generally the degree of tenderness is less than what might be expected in view of the severe pain.

wrist and knee swelling

May be observed on examination.

dental pain, tongue pain, or infarction of the tongue

Oral symptoms and signs may be present.

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