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This is a clinician-written, evidence-based summary aligned to the USMLE Step 2 CK Content Outline. It is intended for medical students preparing for USMLE Step 2 CK. Management reflects current ACC/AHA, USPSTF, and APA guidelines. Always cross-reference with UpToDate, institutional protocols, and clinical judgment.
The Bottom Line
- PMR: age >50 with bilateral shoulder/hip girdle pain and stiffness
- GCA: new headache, scalp tenderness, jaw claudication, visual symptoms in age >50
- Suspected GCA requires immediate high-dose steroids before biopsy
- Temporal artery biopsy or ultrasound supports diagnosis
- PMR and GCA overlap frequently
Overview
PMR and GCA are linked inflammatory diseases of older adults. PMR causes proximal pain and stiffness; GCA is granulomatous large-vessel vasculitis that can cause irreversible vision loss.
Epidemiology
Both occur almost exclusively after age 50, peak in the 70s, and are more common in women and Northern European ancestry.
Clinical Features
Symptoms
Bilateral shoulder and hip girdle aching with morning stiffness
Difficulty rising from chair or lifting arms due to pain
New temporal or occipital headache
Jaw claudication, scalp tenderness, or tongue pain
Transient or persistent visual loss or diplopia
Signs
Painful shoulder/hip ROM with preserved true strength
Temporal artery tenderness, nodularity, or reduced pulse
Visual field defect or afferent pupillary defect
Asymmetric arm BP, bruits, or reduced pulses
No objective muscle weakness
Investigations
First-line
Focused clinical assessmentPattern recognition, red flags, functional impact, and targeted examination
Basic labs when indicatedCBC, CMP, ESR/CRP, CK, urinalysis, or disease-specific testing depending on suspected condition
Initial imaging when indicatedPlain radiographs or MRI/ultrasound based on suspected structural, inflammatory, infectious, or neurologic disease
Second-line
Disease-specific confirmatory testingAutoantibodies, HLA-B27, synovial fluid, nerve conduction studies, DEXA, or cultures as appropriate
MRI/ultrasound/CTUsed for early inflammatory disease, occult fracture, tendon tear, infection, or surgical planning
Screening before immunosuppressionTB, hepatitis, vaccination review, and baseline labs when biologic or high-risk therapy is planned
Specialist
Specialist referralRheumatology, orthopedics, infectious disease, ophthalmology, neurology, or spine surgery depending on red flags and disease severity
1
Initial management
- Address red flags and emergencies first
- Use guideline-directed first-line therapy matched to disease severity
- Educate the patient and set functional goals
- Use analgesia and rehabilitation when appropriate
2
Escalation
- Escalate to specialist-directed therapy if severe, refractory, progressive, or organ-threatening disease
- Use imaging, procedures, immunosuppression, antibiotics, or surgery according to diagnosis
- Monitor response objectively and revise diagnosis if response is atypical
3
Prevention and follow-up
- Manage comorbidities and medication toxicity
- Vaccinate and screen when immunosuppression is used
- Prevent disability, falls, fracture, infection, and functional decline
Complications
- Functional impairment: Pain, weakness, stiffness, deformity, or disability depending on disease
- Diagnostic delay: Missed infection, fracture, inflammatory disease, neurologic compromise, or organ-threatening complication
- Medication toxicity: NSAID, steroid, antibiotic, anticoagulation, opioid, or immunosuppressive adverse effects
- Chronic disease burden: Reduced quality of life, work impairment, deconditioning, and mental health impact
USMLE Step 2 CK Exam Tips
- 1Age >50 + new headache + jaw claudication = GCA
- 2Start steroids immediately; do not wait for biopsy
- 3Visual symptoms are an emergency
- 4PMR causes pain/stiffness, not true weakness
- 5PMR responds dramatically to low-dose prednisone
- 6Temporal artery biopsy can be negative due to skip lesions
practicetest your knowledge on polymyalgia rheumatica & giant cell arteritisApply what you've learnt with USMLE Step 2 CK-style questions from the iatroX Q-Bank — musculoskeletal and beyond.
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