Semih GULLE, Mert Can ATACA, Yesim EREZ, Gercek SEN, Ismail SARI, Fatos ONEN
Rheumatology Quarterly - 2026;4(3):210-217
Objective: Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) represent overlapping manifestations of a common inflammatory disease spectrum with distinct treatment needs and prognostic implications. This study aimed to evaluate clinical features, relapse rates, and long-term treatment outcomes across PMR, GCA, and PMR+GCA patient groups. Methods: The authors retrospectively analyzed 142 patients aged >=50 years diagnosed using ACR/EULAR 2012 (PMR) or 2022 (GCA) classification criteria. Patients were grouped as isolated PMR (n = 68), PMR+GCA (n = 31), or isolated GCA (n = 43). Clinical characteristics, inflammatory markers, imaging findings, and treatment outcomes were compared across groups. Results: Relapse was significantly more frequent in GCA and PMR+GCA groups than in isolated PMR (P < .001). Cumulative corticosteroid dose was lowest in PMR (4.05 +/- 1.1 g) and highest in PMR+GCA (6.85 +/- 1.6 g) (P < .001). Pulse steroid therapy was administered in 64.5% of PMR+GCA and 83.7% of GCA patients, but in none of the PMR patients (P < .001). Early glucocorticoid discontinuation was more common in PMR (66.2%) than in GCA or PMR+GCA groups (P < .001). Steroid-sparing agents were used in 83.8% of the overall cohort, with tocilizumab utilized in only 2.8%. Cardiovascular mortality accounted for 4 of 8 deaths during follow-up. Conclusion: Patients with isolated PMR demonstrated a milder disease course requiring less aggressive therapy, while those with GCA or overlapping disease exhibited higher relapse rates and greater glucocorticoid exposure. Early identification of vasculitic involvement, individualized treatment strategies, and systematic cardiovascular risk assessment are essential for optimizing long-term outcomes in this population.
