Giant cell arteritis/ Polymyalgia Rheumatica

Question 1

Giant cell arteritis

• Inflammatory granulomatous arteritis, esp of ________________
• Is a MEDICAL EMRGENCY may cause loss of vision due to _________________
• Closely a/w ________________ -> predisposes each other!
• Common in elderly – if <55yo, consider _____________
• Natural hx: Typically, 2-year course w complete remission

Answer 1

polymyalgia rheumatica (50%)

branches of ECA (**temporal art & post ciliary art)

Post Ciliary A compromise;

Takayasu’s

Question 2

What is the presentation of a patient with Polymyalgia Rheumatica (PMR)?

Answer 2

Clinical dx

• Pt >50yo, typically >65yo
• Subacute onset (<2/52)
• Severe bilat pain and morning stiffness >1h in shoulders, hips and prox limb muscles.
• Ddx PM: however no muscle weakness, CK normal
• A/w systemic features (1/3): tiredness, fever, weight loss, depression

Question 3

What is the management of Polymyalgia Rheumatica (PMR)? How do you know if treatment is working?

Answer 3

• PO pred 10-15mg OM for 1 month, expect dramatic response within 2days -1 week (if not, consider other ddx eg RA, vasculitis, infection, malig)
• Dose reduce slowly eg 2.5mg/every 2-4weeks, cover w PPI and bisphosphonates
• Seek urgent r/v if symptoms of CGA develops

Response criteria: ↓ESR/CRP, improve in morning stiffness, ability to raise shoulders and global assessment