GCA and PMR

Question 1

Who most commonly gets GCA?

Answer 1

women over 50 in scandanavia

Question 2

Which arteries are affected in GCA?

Answer 2

external carotid, opthalmic, vertebral, distal subclavian, axillary, thoracic aorta

Question 3

What are the four different clinical patterns of GCA?

Answer 3

1. isolated cranial GCA (headache, jaw claudication, scalp tenderness)
2. symptomatic LVV (claudication, pulseless limb) with or without associated cranial signs
3. isolated fever or inflammatory response
4. isolated PMR with vasculitis on imaging

Question 4

What are the visual symptoms and signs in GCA?

Answer 4

vision loss, transient visual blurring, sudden loss of vision, eye pain, dipolopia, nystagmus, INO

Question 5

What is the most common cause of vision loss in GCA?

Answer 5

anterior ischaemic optic neuropathy

Question 6

What are the differential diagnoses for headache in GCA?

Answer 6

cluster headache, migraine, tension headache, sinusitis, trigeminal neuralgia, opthalmic shingles, skull metastasis

Question 7

What are the differential diagnoses for high ESR in GCA?

Answer 7

PMR, small/medium vessel vasculitis, endocarditis, malignancy, temporo-mandibular joint disorder

Question 8

What investigations should be ordered to investigate ?GCA?

Answer 8

FBE, UEC, LFT, ESR, CRP, urine dipstick, CXR, CT head

Question 9

What percentage of GCS patients have a normal ESR?

Answer 9

4%

Question 10

What is the gold standard for diagnosis of GCA?

Answer 10

temporal artery biopsy

Question 11

What is the sensitivity of TAB in cranial GCA?

Answer 11

70-90%

Question 12

What is the sensitivity of TAB in large vessel GCA?

Answer 12

52%

Question 13

Why might a TAB be negative in GCA?

Answer 13

skip lesions, sampling errors, extracranial large vessel GCA

Question 14

What imaging modalities can be used in GCA?

Answer 14

US, MRI, PET, CT angiogram

Question 15

Why is MRI a useful imaging test in GCA?

Answer 15

because it has a negative predictive value of 98.2%

Question 16

What is the management of GCA?

Answer 16

start steroids as soon as suspected to minimise risk of vision loss

Question 17

What are the complications of GCA and its treatment?

Answer 17

infections, osteoporosis, cataracts, diabetes

Question 18

What are the long term risks of GCA?

Answer 18

aortic aneurysm (5 years) - need annual CXR

Question 19

What is the role of aspirin in GCA?

Answer 19

reduces rate of visoon loss and ischaemic complications

Question 20

What is the role of methotrexate in GCA?

Answer 20

reduces risk of relapse

Question 21

What other drugs have been shown to be beneficial in GCA?

Answer 21

cyclophosphamide, azathioprine, leflunomide, tociluzimab, ustekinumab

Question 22

Is anti TNF therapy useful in GCA?

Answer 22

no

Question 23

What are the mandatory criteria for PMR?

Answer 23

age > 50, aching both shoulder, abnormal CRP/ESR

Question 24

What are the clnical features of PMR?

Answer 24

aching and stiffness in neck/shoulders, prolonged morning stiffness, normal muscle strength but testing limited by pain

Question 25

What is the differential diagnosis for PMR

Answer 25

seronegative RA
regional soft tissue rheumatism
subacromial bursitis/supraspinatus tendinitis
myeloma
myositis
drug induced myopathy and myalgia
fibromyalgia
parkinsons

Question 26

What investigations should be ordered for PMR?

Answer 26

CRP/ESR, RF,CCP, SPEP, CK

Question 27

What imaging can be used for PMR/

Answer 27

PET

Question 28

What dose of prednisolone is used in pMR

Answer 28

15mg a day for 4/52 then wean

Question 29

What other medications may be useful in PMR?

Answer 29

methotrexate, anti TNF agents (etanercept)

Question 30

What should be done to prevent complications in PMR?

Answer 30

monitor bone health, vaccinate