Polymyalgia Rheumatica and Giant Cell Arteritis 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%
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
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
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
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
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
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
