RHEUM: GCA and polymyalgia rheumatica Flashcards Preview

Year 3 Medicine Block > RHEUM: GCA and polymyalgia rheumatica > Flashcards

Flashcards in RHEUM: GCA and polymyalgia rheumatica Deck (14)
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1
Q
A
2
Q

Define giant cell arteritis

A

Chronic vasculitis of large and medium sized vessels in individuals over 50yrs.

3
Q

Why is giant cell arteritis an emergency?

A

Occlusive arteritis can lead to anterior ischaemic optic neuropaty and acute visual loss. The visual symptoms are an opthalmoc emergency

4
Q

What are the risk factors for GCA aka Temporal arteritis?

A

Age
White ethnicity
PMH of polymyalgia rheumatica
Genetic predisposition with HLA-DR4

5
Q

How does GCA present?

A

Presentation is acute
Headaches in 70% of presentations
Localised, unilateral, piercing or stabbing over the temple
Tongue and/or jaw claudication upon mastication
Constitutional symptoms
Visual symptoms
Scalp tenderness, especially over temporal artery

6
Q

How is giant cell arteritis diagnosed?

A
  • Over 50
  • The presence of two or more of these symptoms:
    Raised ESR, CRP or PV
    New onset of localised headache
    Tenderness or decreased pulsation of temporal artery
    New visual symptoms
    Biopsy of necrotizing arteritis
7
Q

How is GCA treated?

A
  • Prednisolone 60-100mg PO per day for at least 2 weeks then slowly reduce
  • if visual symptoms are present - 1g methylprednisolone IV pulse therapy for 1-3 days
  • low dose aspirin therapy to reduce thrombotic risks
8
Q

What is your immediate managment in pt with suspected GCA?

A

Steroid therapy

9
Q

How is polymyalgia rheumatica (PMR) characterised?

A

Pain and stiffness in shoulder, hip girdles and neck.

10
Q

Who does PMRF usually affect?

A

The elderly - incidence increases with age. Average age is 70.
Affects patients with GCA (there’s evidence that PMR and GCA are associated to one another)

11
Q

How does PMR present (just from a history)?

A

Sudden onset of pain in proximal limbs - so the neck, shoulders and hips.
Difficulty getting up from chair (hip pain), and combing hair (shoulder pain).
Pain at night time
Systemic symptoms - fatigue, weight loss, low grade fever

From Z2F:
Presence of symptoms for at least 2 weeks
Bilateral shoulder pain that radiates to the elbow
Bilateral pelvic girdle pain
Worse with movement
Interferes with sleep
Stiffness for at least 45 minutes in the morning

May also have systemic symptoms - weight loss, fatigue, low grade fever, low mood 
Upper arm tenderness
Carpal tunnel syndrome
Pitting oedema

12
Q

What investigations may you consider for pt with suspected PMR?

A

Bloods - ESR, CRP, polycythemia vera

Temporal artery biopsy if symptoms of GCA

13
Q

What is the difference between GCA and trigeminal neuralgia?

A

GCA- chronic vasculitis of large and medium sized vessels in the head whereas TRIGEMINAL NEURALGIA- compression of trigeminal nerve

GCA- presents with headaches, stabbing facial pain and visual disturbances
TRIGEMINAL NEURALGIA- electric shock and knife pain unilaterally

14
Q

Name 2 differentials of poly myalgia rheumatica

A

Osteoarthritis, rheumatoid arthritis, SLE, myositis, cervical spondylitis, frozen shoulder (in both shoulders), hyper or hypo thyroidism, osteomalacia, fibromyalgia

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