The ACR has published its updated recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) for patients receiving >3 months treatment with glucocorticoids (GCs) ≥2.5 mg daily. Despite increasing treatment options to prevent and treat GIOP, many GC-treated patients are not evaluated or treated.

As the sole effective treatment for polymyalgia rheumatica since their development in the 1950’s until recently, the impact of glucocorticoids and PMR outcomes are undeniably intertwined. So much so that when the OMERACT PMR working group first set out to develop a PMR core outcome set, they quickly realised that many of the outcomes important to patients were related to their glucocorticoid use.

When we are considering a diagnosis of PMR, it is key to evaluate the patient accurately and efficiently. Can we use a synchronous audiovisual visit or a rheumatology eConsult to evaluate the patient's symptoms quickly? Does it allow us to make an accurate diagnosis? I would argue that for most of these cases we indeed can. 

For decades we've been screening GCA with a patient history and exam. Doing so with imaging would be a sharp departure from the current standard of care. And you may be asking yourself, well, yeah, but what could it hurt? Don't you want to catch GCA early?  Let me tell you the problems with this.