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PMR to GCA Escalation — SCE Rheumatology MCQ

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EasyVasculitisPMR to GCA EscalationSCE Rheumatology

A 55-year-old woman with PMR develops new cranial symptoms (headache jaw claudication visual disturbance) while on Prednisolone 8 mg daily. What dose adjustment is needed?

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Correct answer: E — Increase Prednisolone immediately to GCA doses (40-60 mg daily) as cranial GCA symptoms indicate progression requiring urgent treatment escalation

Development of cranial GCA symptoms in a patient with PMR is a medical emergency requiring immediate dose escalation to GCA treatment doses (40-60 mg Prednisolone daily). Visual symptoms may require IV Methylprednisolone. BSR 2020 GCA guidelines recommend that all PMR patients be counselled about GCA warning symptoms (new headache visual changes jaw claudication scalp tenderness) and advised to seek immediate medical attention. The PMR maintenance dose (typically 5-10 mg) is insufficient for GCA which requires much higher initial doses to prevent irreversible visual loss.

Reference: BSR 2020 GCA guidelines; BSR 2010 PMR guidelines