A 72-year-old woman has a 3-week history of bilateral shoulder and hip girdle pain with morning stiffness lasting more than an hour. She has difficulty getting out of a chair and combing her hair. There is no joint swelling. Her CRP and ESR are raised. Polymyalgia rheumatica is suspected.

Which additional feature should prompt urgent assessment for giant cell arteritis?

  1. Bilateral shoulder pain
  2. Morning stiffness lasting more than 45 minutes
  3. Jaw claudication
  4. Raised ESR
  5. Age over 50

Answer: C — Jaw claudication

Polymyalgia rheumatica and giant cell arteritis are closely related and can occur together. Bilateral shoulder and hip girdle pain, prolonged morning stiffness, raised inflammatory markers and age over 50 are features of polymyalgia rheumatica itself, so they do not on their own point to arteritis.

Jaw claudication, a new headache, scalp tenderness, visual disturbance and systemic features such as weight loss suggest giant cell arteritis. These features matter because arteritis can cause permanent visual loss, so a patient with them needs urgent assessment through a fast-track pathway.

Clinical Tip: In suspected polymyalgia rheumatica, always ask about headache, jaw claudication, scalp tenderness and visual symptoms, because they point to giant cell arteritis.

Reference: British Society for Rheumatology guideline on the diagnosis and treatment of giant cell arteritis (2020); BSR guideline on polymyalgia rheumatica (2015).