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Rheumatology > E: Polymyalgia Rheumatic + Giant Cell Arteritis > Flashcards

E: Polymyalgia Rheumatic + Giant Cell Arteritis Flashcards

(54 cards)

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1
Q

What is polymyalgia rheumatic

A

Autoimmune, Inflammatory, Rheumatic Disease

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2
Q

What age does PMR tend to occur and what is the peak incidence

A

Occurs in >50y

Peak incidence is 70-80y

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3
Q

In which gender is PMR more common

A

Female (3:1)

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4
Q

What is the aetiology of PMR

A

Combination of genetic and environmental factors:

  • Genetic: HLA DR4
  • Environmental: parvovirus B19 and adenovirus infection
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5
Q

What genetic factor predisposes to PMR

A

HLA DR4

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6
Q

What condition if PMR associated with

A

Giant Cell Arteritis

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7
Q

What % of patients with PMR will have GCA

A

10-20%

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8
Q

What are the musculoskeletal symptoms of PMR

A
  • Bilateral shoulder, pelvic girdle and neck pain. (May start in one side - and progress to be bilateral in weeks)
  • Morning stiffness >45m
  • Nocturnal pain
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9
Q

What are the systemic symptoms of PMR

A
  • Lethargy
  • Low grade fever
  • Malaise
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10
Q

What are the two investigations for PMR

A
  1. ESR

2. Creatinine kinase

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11
Q

How will ESR present in PMR

A

> 50

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12
Q

How will Creatinine Kinase present in PMR and why is this important

A

It will be NORMAL - this is important to differentiate PMR from other inflammatory rheumatic disorders

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13
Q

What drug is given to manage PMR

A

Prednisolone

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14
Q

What dose of prednisolone is initially given in PMR and how long is this continued

A

15mg/day. This is continued until symptoms resolve

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15
Q

Explain dose tapering of prednisolone

A
  • 15mg/d. until symptoms resolve
  • 12.5mg/d for 3W
  • 10mg/d for 4-6W
  • then reduce by 1mg every 4-8W until dose is stopped
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16
Q

What should anyone on prednisolone be given

A

Blue steroid card

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17
Q

What are 5 complications of PMR

A
  • GCA
  • Fibromyalgia
  • Dermatomyositis
  • Polymyositis
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18
Q

What is giant cell arteritis

A

vasculitis affecting medium to large sized vessels

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19
Q

which gender is GCA more common

A

female

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20
Q

which age is GCA typically seen in

A

> 50y.

Peak incidence of 70-80y

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21
Q

which heritage is giant cell arteritis commonly seen in

A

Northern European Descent

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22
Q

what is the aetiology of giant cell arteritis

Study These Flashcards
A

Thought to be a combination of genetic and environmental factors.
Genetic = due to HLADR4
Environmental = infection with parvovirus B19 or adenovirus

23
Q

what % of patients with GCA will have polymyalgia rheumatic

24
Q

how will GCA present clinically

Study These Flashcards
A
  • dull, throbbing, pulsating headache over temples
  • tenderness over temporal artery to palpate (combing hair)
  • jaw claudication
  • fever
  • malaise
  • lethargy
25
why is the headache a pulsating, dull throbbing over the temples
due to GCA affecting temporal artery
26
why do patients have jaw claudication
due to GCA affecting facial artery
27
what eye symptoms will patients eventually present with in GCA
First present with a scintillating scotoma which will then progress to amaurosis fugax
28
what is amaurosis fugax
painless sudden loss of vision in one eye
29
what causes amaurosis fugax in GCA
anterior ischaemic optic neuropathy due to affecting the ophthalmic artery
30
what other symptoms may patients with GCA have
symptoms of PMR (50%) | - bilateral shoulder, pelvic, neck pain
31
Explain pathophysiology of GCA
- activation of dendritic cells in adventitia of blood vessels recruits monocytes - monocytes differentiate to macrophages and produce cytokines (IL6) - macrophages produce MMP which destroy blood vessels - PDGF and VEGF from macrophages causes proliferation of blood vessel intima that reduces blood flow and leads to ischaemia
32
what should be done before investigating in GCA and why
management. As individuals with GCA can go blind within 48h
33
What 3 tests may be ordered in GCA
1. ESR 2. FBC 3. Temporal artery biopsy
34
what will ESR show in GCA
Isolated raised ESR. (CRP may also be raised but disproportionately to CRP)
35
what will FBC show in GCA
normocytic normochromic anaemia
36
what is gold-standard investigation for GCA
temporal artery biopsy
37
which patients should receive a temporal artery biopsy
All patients
38
why may a temporal artery biopsy return normal
due to skip lesions
39
if temporal artery biopsy is negative, but you suspect GCA what should be done
treat as GCA
40
what will be seen on temporal artery biopsy
granulomatous inflammation of tunica intima
41
what criteria is used to identify GCA
American college of rheumatology
42
what is a mneumonic to remember american college of rheumatology criteria for GCA
H.A.T.E.H
43
what does the american college of rheumatology state must be present to identify GCA
``` Headaches Age >50y Temporal artery dysfunction ESR >50 Histological evidence on temporal artery biopsy ```
44
what is first-line management for giant cell arteritis
Oral prednisolone
45
if people have visual symptoms of GCA what dose of prednisolone should be given
60mg
46
if people with GCA do not have visual symptoms, what dose of prednisolone should be given
40-60mg
47
if individuals do not respond to prednisolone in 48h what should be done
Seek advice - consider alternative diagnosis
48
over what time frame is the dose of prednisolone tapered
1-2y. Whilst during this time recurrence may occur
49
if someone with GCA has visual disturbances what is done
same-day referral to ophthalmology
50
in addition to prednisolone what other medication is given
aspirin
51
what dose of aspirin is given in GCA
75mg
52
what must be given with aspirin
omeprazole 20mg
53
what are 3 complications of GCA
- cerebral ischaemia - aortic aneurysm - permanent visual loss
54
what % of individuals with GCA will develop permanent visual loss
20-30%

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