GCA and PMR Flashcards
Who most commonly gets GCA?
women over 50 in scandanavia
Which arteries are affected in GCA?
external carotid, opthalmic, vertebral, distal subclavian, axillary, thoracic aorta
What are the four different clinical patterns of GCA?
- isolated cranial GCA (headache, jaw claudication, scalp tenderness)
- symptomatic LVV (claudication, pulseless limb) with or without associated cranial signs
- isolated fever or inflammatory response
- isolated PMR with vasculitis on imaging
What are the visual symptoms and signs in GCA?
vision loss, transient visual blurring, sudden loss of vision, eye pain, dipolopia, nystagmus, INO
What is the most common cause of vision loss in GCA?
anterior ischaemic optic neuropathy
What are the differential diagnoses for headache in GCA?
cluster headache, migraine, tension headache, sinusitis, trigeminal neuralgia, opthalmic shingles, skull metastasis
What are the differential diagnoses for high ESR in GCA?
PMR, small/medium vessel vasculitis, endocarditis, malignancy, temporo-mandibular joint disorder
What investigations should be ordered to investigate ?GCA?
FBE, UEC, LFT, ESR, CRP, urine dipstick, CXR, CT head
What percentage of GCS patients have a normal ESR?
4%
What is the gold standard for diagnosis of GCA?
temporal artery biopsy
What is the sensitivity of TAB in cranial GCA?
70-90%
What is the sensitivity of TAB in large vessel GCA?
52%
Why might a TAB be negative in GCA?
skip lesions, sampling errors, extracranial large vessel GCA
What imaging modalities can be used in GCA?
US, MRI, PET, CT angiogram
Why is MRI a useful imaging test in GCA?
because it has a negative predictive value of 98.2%
What is the management of GCA?
start steroids as soon as suspected to minimise risk of vision loss
What are the complications of GCA and its treatment?
infections, osteoporosis, cataracts, diabetes
What are the long term risks of GCA?
aortic aneurysm (5 years) - need annual CXR
What is the role of aspirin in GCA?
reduces rate of visoon loss and ischaemic complications
What is the role of methotrexate in GCA?
reduces risk of relapse
What other drugs have been shown to be beneficial in GCA?
cyclophosphamide, azathioprine, leflunomide, tociluzimab, ustekinumab
Is anti TNF therapy useful in GCA?
no
What are the mandatory criteria for PMR?
age > 50, aching both shoulder, abnormal CRP/ESR
What are the clnical features of PMR?
aching and stiffness in neck/shoulders, prolonged morning stiffness, normal muscle strength but testing limited by pain
What is the differential diagnosis for PMR
seronegative RA regional soft tissue rheumatism subacromial bursitis/supraspinatus tendinitis myeloma myositis drug induced myopathy and myalgia fibromyalgia parkinsons
What investigations should be ordered for PMR?
CRP/ESR, RF,CCP, SPEP, CK
What imaging can be used for PMR/
PET
What dose of prednisolone is used in pMR
15mg a day for 4/52 then wean
What other medications may be useful in PMR?
methotrexate, anti TNF agents (etanercept)
What should be done to prevent complications in PMR?
monitor bone health, vaccinate
