Polymyalgia rheumatica and giant cell arteritis

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Abstract
EDITOR,--We disagree with Gillian Pountain and Brian Hazleman's assertion that 20-40 mg of prednisolone is adequate initial treatment for patients with giant cell arteritis who have no ocular symptoms. As the authors state, appreciable visual loss occurs in 30-50% of patients with untreated giant cell arteritis. Anterior ischaemic optic neuropathy accounts for 90% of these cases, the remainder being secondary to retinal artery occlusions or, rarely, an ocular ischaemic syndrome. Although prodromal symptoms such as transient obscuration of vision …