PMR + GCA Flashcards

1
Q

Polymyalgia rheumatica (PMR) is not a true vasculitis and its pathogenesis is unknown. PMR and GCA share the same demographic characteristics, although separate conditions, they frequently occur together.

What are clinical features of PMR?

A
  • Age >50yrs
  • Subacute onset (<2wks)
  • bilateral aching, tenderness and morning stiffness
  • in shoulder, hips, proximal limbs
  • (low-grade) fever
  • weight loss + anorexia
  • lethargy + depression
  • mild polyarthritis, tenosynovitis + carpal tunnel syndrome in <10%
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2
Q

For PMR, histology shows vasculitis w/ giant cell arteritis, characteristically ‘skips’ certain sections of affected artery whilst damaging others. Muscle bed arteries affected most in polymyalgia rheumatica.

What investigations are done for PMR?

A
  • CRP raised
  • ESR typically >40 (but may be normal)
  • ALP increased in 30%
  • CK levels + EMG normal (differentiates from myositis)
  • Reduced CD8+ T cells
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3
Q

What is the treatment for polymyalgia rheumatica?

A
  • Prednisolone 15mg OD → expect dramatic response within 1wk; reduce dose slowly
    • normally needed >2yrs to give bone protection
  • Inform patients to seek urgent review if symptoms of GCA develop
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4
Q

What is giant cell arteritis (GCA)?

A
  • large vessel vasculitis
  • giant cell arteritis = temporal cell arteritis
  • it’s a systemic granulomatous arteritis, granulomatous lesions seen on 50% of biopsies
  • affects females > males
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5
Q

What are clinical features of GCA?

A
  • typically pt >60yrs
  • usually rapid onset (<1 month)
  • headache
  • scalp tenderness (eg. when combing hair)
  • jaw claudication
  • amaurosis fugax or sudden bilateral blindness
  • PMR preceding symptoms
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6
Q

What investigations are done for GCA?

A
  • ESR + CRP increased
  • Platelets increased
  • ALP increased
  • Hb low
  • Temporal artery biopsy within 14 days of starting steroids
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7
Q

What is the management of GCA?

A
  • Prednisolone high dose (60mg OD)
  • urgent ophthalmology review in pts w/ visual symptoms (same day)
  • referral to rheumatologist
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