Ch 20: Rheumatologic, Immunologic, & Allergic Disorders

Question 1

What are the essentials of diagnosis for polymyalgia rheumatica and giant cell arteritis?

Answer 1

Age over 50 years.
Giant cell (temporal) arteritis is characterized by headache, jaw claudication, polymyalgia rheumatica, visual abnormalities, and a markedly elevated ESR.
The hallmark of polymyalgia rheumatica is pain and stiffness in shoulders and hips lasting for several weeks without other explanation.

(p. 853)

Question 2

What type of aneurysms are 17 times more common in people with giant cell arteritis?

Answer 2

thoracic aortic aneurysms

Question 3

What is Takayasu arteritis?

Answer 3

Takayasu arteritis is a granulomatous vasculitis of the aorta and its major branches.

Question 4

Polymyalgia rheumatica and giant cell arteritis probably represent a spectrum of one disease: both affect the same population (patients over the age of 50), show preference for the same HLA haplotypes, and show similar patterns of…

Answer 4

…cytokines in blood and arteries.

p. 853

Question 5

The primary difference between polymyalgia rheumatica and giant cell arteritis is that polymyalgia rheumatic alone does not cause…

And giant cell arteritis can cause…

Answer 5

…blindness and it does respond to low dose prednisone.

…blindness and large artery complications and requires high-dose prednisone.

(p. 854)

Question 6

In what fraction of cases does polymyalgia rheumatica occur in the ABSENCE of giant cell arteritis?

Answer 6

2/3 of cases

p. 854

Question 7

Why is giant cell arteritis also called temporal arteritis?

Answer 7

Because that artery is frequently involved, as are other extracranial branches of the carotid artery.

(p. 854)

Question 8

What fraction of patients with giant cell arteritis also have polymyalgia rheumatica?

Answer 8

1/2

p. 854

Question 9

What are the classic symptoms of giant cell arteritis?

Which of these symptoms has the highest positive predictive value?

Answer 9

headache, scalp tenderness, visual symptoms (particularly diplopia or amaurosis fugax, which is a temporary loss of vision in one or both eyes), jaw claudication, or throat pain.

Jaw claudication

(p. 854)

Question 10

What are the laboratory findings of polymyalgia rheumatica?

Answer 10

anemia and elevated acute phase reactants, especially ESR
However, it can occur with normal acute phase reactants

(p. 854)

Question 11

90% of patients with giant cell arteritis have ESRs higher than…

However, the ___ is a more sensitive test for giant cell arteritis.

Answer 11

….50 mm/h.

CRP (C reactive protein)

(p. 854)

Question 12

When a patient has symptoms and findings suggestive of temporal arteritis, therapy with __________ (60 mg/day orally) should be initiated immediately and a ________ ______ ______ performed promptly.

Answer 12

prednisone

temporal artery biopsy

Question 13

Compensated polarized light microscopy identifies and distinguishes monosodium urate (gout, __________ ____________) and calcium _____________ (pseudogout, ________ birefringent) crystals.

Answer 13

negatively birefringent
pyrophosphate
positive

(Remember 3 p’s, positive pyrophosphate, pseudogout)