Nocturnal pain that disturbs sleep is also common. Physical examination may elicit some tenderness over the affected muscles and painful limitation of hip and shoulder movements, but the tenderness is mild compared with the severity of symptoms. The wrists, knees, and fingers may be swollen and tender. Although this test is very sensitive, the results are occasionally normal, particularly with polymyalgia rheumatica. Liver enzyme levels are mildly elevated in one third of patients.
Patients often have a normochromic-normocytic anemia.
Treatment with corticosteroids can be started up to 1 week before biopsy without affecting biopsy results. Treatment should not be delayed to accommodate biopsy. In exceptional circumstances, a biopsy of the contralateral artery may be justified. The role of temporal artery biopsy in patients with symptoms of only polymyalgia rheumatica is controversial. A reasonable approach is to forgo biopsy and instead follow the patient's clinical symptoms, ESR, and response to treatment.