PMR & GCA Flashcards
what is PMR (including what 3 body parts are involved)
syndrome of muscle pain and stiffness involving neck, shoulder and hips
which is more common– GCA or PMR?
PMR
relationship btwn GCA and PMR
half of ppl w/ GCA will have PMR but only 15% of those w/ PMR will have GCA
what is the condition?
- symmetric proximal muscle stiffness or tenderness in neck shoulders, low back, hips, thighs
- systemic sx
- swelling of hands, wrists, ankles, top of feet
PMR
if high spiking fevers, consider GCA
expected muscle strength & ROM in patients with PMR
-normal strength, decreased ROM
expected ESR/CRP, CBC, ANA, RF, CPK findings w/ PMR
- elevated ESR, CRP
- mild to mod anemia
- normal everything else
to diagnose PMR you need what 4 things
- over 50
- sx at least 2/3 of neck/torso, shoulders/proximal arms, hips/proximal thighs
- elevated ESR
- fast response to prednisone
how is PMR tx?
Prednisone 10-20 mg/day x 1-2 years
monitor for signs of GCA– if you need high dose it might be it
PMR prognosis
self limiting, will resolve in 1-2 yrs
most common vasculitis; large vessel vasculitis involving major branches of the aorta, mainly cranial arteries
GCA
- new unilateral HA
- abrupt onset of visual issues like transient monocular visual loss
- jaw claudication
- FUO, anemia, consitutional sx
GCA
expected ESR/CRP, CBC findings w/ GCA
- ESR or CPR over 100
- anemia of chronic dz; increased platelets
which condition do you see Ischemic optic neuropathy– swollen optic disc w/ blurred margins
GCA
what are the 5 parts of the ACR criteria used in diagnosing GCA
- over 50
- localized HA new onset
- tender or decreased temporal pulse
- ESR over 50 mm/hr
- biopsy w/ necrotizing arteriris & monomuclear cells ; lymphocyte infiltration, lumen narrowing
how is GCA treated? (3)
- prednisone 1mg/kg/day tapered over 2 yrs
- methylprednisolone 1000 mg IV to prevent visual loss
- Tocilizumab (anti IL-6)– glucocorticoid sparing agent
