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PMR-GCA Overlap — SCE Rheumatology MCQ

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EasyVasculitisPMR-GCA OverlapSCE Rheumatology

A 65-year-old woman with known PMR on Prednisolone 8 mg daily presents with new-onset severe unilateral headache and anterior ischaemic optic neuropathy. What does this presentation indicate about the relationship between PMR and GCA?

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Correct answer: D — Approximately 15-20% of PMR patients have concurrent or develop GCA and all PMR patients should be monitored for GCA symptoms

PMR and GCA exist on a spectrum with approximately 15-20% of PMR patients having concurrent GCA and up to 50% of GCA patients having PMR features. All patients with PMR should be counselled about GCA warning symptoms (new headache visual symptoms jaw claudication scalp tenderness) and advised to seek immediate medical attention if these develop. BSR 2020 GCA guidelines and PMR guidelines emphasise this overlap. Inability to taper steroids below 10 mg in PMR should also raise suspicion for underlying GCA.

Reference: BSR 2020 GCA guidelines; Dasgupta B et al 2012 ACR/EULAR PMR criteria