Updated recommendations
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EULAR – The European Alliance of Associations for Rheumatology – last published recommendations on the management of polymyalgia rheumatica (PMR) in 2015, and in 2018 for giant cell arteritis (GCA) and Takayasu arteritis (TAK). Since then, new evidence has become available, so the recommendations have been updated – and merged under one new piece on PMR and large vessel vasculitis (LVV).
EULAR first published recommendations for LVV in 2009, with a subsequent update in 2018, and PMR recommendations were released in 2015. Advances in both treatment and diagnosis since then meant a review was due. Additionally, it is now recognised that there are significant pathophysiological similarities between GCA and TAK, and in the clinical presentation of PMR and GCA – and this overlap has led to the management of PMR, GCA, and TAK being addressed in a single set of recommendations. Researchers, healthcare professionals, and patients worked together to develop this new advice.
The new work, published in the July 2026 issue of the
Annals of the Rheumatic Diseases, includes 12 individual recommendations and four overarching principles. The principles state that diagnosis is based on signs and symptoms – confirmed by biopsy or imaging in suspected GCA or TAK – and classification criteria should not be used for diagnosis. All management decisions should be made in partnership between the clinician and patient after an informed discussion considering efficacy, safety, and cost. Patients should have access to education about the impact of their disease, as well as key warning symptoms, treatment, and treatment-related complications. Finally, people with LVV should be screened for treatment-related and cardiovascular comorbidities, and prophylactic treatment and lifestyle interventions considered.
Of the 12 recommendations, 5 are completely new, and 7 are updates of previous versions. These focus on referral and assessment, treatment, relapse and re-evaluation, and possible endovascular interventions or surgery that may be needed. For all patients, regular follow-up and monitoring should be based on symptoms, clinical findings, and acute phase markers – with imaging used to assess for damage on an individual basis in GCA, and to assess for activity and damage in TAK.
“These recommendations represent a distillation of the current evidence, and we have kept the physician-patient relationship in mind when designing them,” said Chetan Mukhtyar – lead author on the new paper and Consultant Rheumatologist at Norfolk and Norwich University Hospitals in the United Kingdom. “The recommendations will be valuable to all healthcare providers when faced with patients suffering with symptoms that suggest PMR or LVV. A major takeaway is that patients with suspected PMR should be assessed by specialists, and it is no longer acceptable to attempt a ‘diagnostic trial of glucocorticoid’. In turn, it is up to the rheumatology community to ensure people are seen in a timely manner.”
Two quality indicators are also included in the new publication, with suggested audit measures to ensure glucocorticoid dose and taper are monitored, and to collect data on the use of adjunctive immunosuppression.
On this point, Chetan Mukhtyar noted “There are also messages in here for funding authorities to ensure that access to recommended drugs is streamlined. Glucocorticoids are hugely important, but they are also associated with a side effect burden. We have stressed throughout the recommendations that the goal of treatment should be glucocorticoid-free remission of disease.”
EULAR hopes this single set of practical recommendations and algorithms will help to improve the treatment and outcomes for patients suffering from these challenging diseases.
Source
Mukhtyar CB, et al. 2025 EULAR Recommendations for the Management of Polymyalgia Rheumatica and Primary Large Vessel Vasculitis. Ann Rheum Dis 2026;
doi.org/10.1016/j.ard.2026.06.009
About EULAR
EULAR is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with rheumatic and musculoskeletal diseases (RMDs). EULAR aims to reduce the impact of RMDs on individuals and society, as well as improve RMD treatments, prevention, and rehabilitation. To this end, EULAR fosters excellence in rheumatology education and research, promotes the translation of research advances into daily care, and advocates for the recognition of the needs of those living with RMDs by EU institutions.
Contact
EULAR Communications,
communications@eular.org
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