Improving polymyalgia rheumatica care: Considerations for routine vascular ultrasound in clinical practice

Vascular ultrasound can be useful in the diagnostic investigation of patients with suspected giant cell arteritis. The clinical overlap between polymyalgia rheumatica and giant cell arteritis raises the prospect that vascular ultrasound can be used to identify features suggestive of giant cell arteritis in polymyalgia rheumatica, and has generated debate on whether all patients with polymyalgia rheumatica should undergo vascular ultrasound. However, before this approach becomes routine practice, more careful and detailed scrutiny is needed of its clinical necessity, patient benefit, and cost-effectiveness, where data are currently lacking. We argue that the case for universal vascular ultrasound screening in polymyalgia rheumatica is speculative and there is a greater necessity to direct resources to address misdiagnosis and overtreatment with glucocorticoids, which carry risks such as osteoporosis, diabetes, ocular morbidity, and infection.