A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure (bilateral blood pressure measurement; arm claudication – weakness/pain of one arm due to aortic arch syndrome; blood pressure side difference; in up to 15% of cases), pulse, body temperature, body weight, body height; furthermore:
- Inspection (observation).
- Skin, mucous membranes, and sclerae (white part of the eye) [extremely rare: scalp or tongue necrosis]; if necessary, chewing gum test to objectify jaw claudication (load-dependent pain in the temple and jaw area)
- Gait pattern (fluid, limping) [lower extremity claudication].
- Body or joint posture (erect, flexed, relieving posture).
- Palpation (palpation) of temporal arteries [thickened and hardened; pulseless in about 1/3 of all RZA cases].
- Auscultation (listening) of the arteries including subclavian artery (subclavian artery) and axillary artery (axillary artery) in lateral comparison [axillary flow noise is considered specific in the diagnosis of RZA]
- Inspection (observation).
- Ophthalmologic examination [due tosymptoms of RZA (70% of cases):
- Eye pain
- Amaurosis fugax (transient blindness; regression of blindness within minutes).
- Orthopedic examination [due tosymptoms of polymyalgia rheumatica:
- Stiffness of the muscles, especially long-lasting morning stiffness (> 45 min).
- Weakness of the musculature
- Bilateral (bilateral) bursitis (bursitis) subdeltoid (between the joint capsule of the shoulder joint and the deltoid muscle)/subacromialis (under the coracoid process (acromion) of the scapula)]
- Neurological examination [due tosymptoms of giant cell arteritis:
- Polyneuropathy (generic term for diseases of the peripheral nervous system associated with chronic disorders of peripheral nerves or parts of nerves) – occurs in circa one quarter of affected individuals]
- Cancer prevention
Square brackets [ ] indicate possible pathological (pathological) physical findings. Caution. Giant cell arteritis (RZA) is associated with polymyalgia rheumatica in more than 50% of cases.