MSK and Rheum - Polymyalgia Rheumatica, Temporal Arteritis, Polyarteritis Nodosa Flashcards
Polymyalgia Rheumatica - what is it?
Condition characterised by muscle stiffness and raised inflammatory markers
Polymyalgia Rheumatica - who does it affect and how quickly?
Commonly >60yo
Rapid onset <1 month
Polymyalgia Rheumatica - what are the clinical features?
MORNING STIFFNESS in proximal limb muscles
Weakness is NOT considered a symptom
Low-grade fever, night sweats
Polyarthralgia
Polymyalgia Rheumatica - what are the investigations and the associated blood product levels?
Rasided inflamm markers = ESR >40mm/hr
Creatine Kinase (CK) = NORMAL, way to differentiate from other disorders
Polymyalgia Rheumatica - management?
PREDNISOLONE 15mg OD
Patients should respond dramatically to steroids - so if they don’t consider diff diagnosis
Temporal Arteritis - what is it?
It is a large vessel vasculitis
Overlaps with polymyalgia rheumatica
Temporal Arteritis - what are the overlapping features with PMR?
Older people >60yo
Rapid onset <1 month
Clinical features - 50% have features of PMR:
1. Morning stiffness, but not weakness
Temporal Arteritis - what are the clinical features?
- Morning stiffness in proximal limb muscles, but NOT WEAKNESS
- VISUAL DISTURBANCES - double vision, amaurosis fugax, blurring
- Headache
- Jaw claudication
- Tender, palpable temporal artery
Temporal Arteritis - what are the investigations and what would you see?
Bloods:
1. Inflamm markers RAISED = ESR >50mm/hr
- Temporal artery biopsy - SKIP LESIONS PRESENT
- VISION TESTING - results changes initial management step
- CK = NORMAL, like in PMR
- EMG = normal
Temporal Arteritis - management?
Urgent glucocorticoids given before biopsy, as soon as TA suspected:
- If NO vision disturbances = high-dose prednisolone
- If there IS visual disturbances = IV methylprednisolone given first, then high-dose prednisolone
- Same day ophthalmology review
- Consider giving bisphosphonates as patient on long-term course of steroids (risk of osteoporosis)
Polyarteritis Nodosa (PAN) - what is it?
It is a vasculitis affecting medium sized arteries with necrotizing inflammation leading to aneurysm formation
Affects many organs
Associated with HepB
PAN - what is the characteristic disease it is associated with?
HepB
PAN - when does it present?
Presents more in men, aged 40-60yo
PAN - what are the clinical features?
Kidney – renal failure, HAEMATURIA
Coronary – ischemic heart disease, acute myocardial infarction
GI – abdominal pain, nausea, melaena, WEIGHT LOSS
Musculoskeletal – arthritis, myalgia, arthralgia
Skin - LIVEDO RETICULARIS
CNS – eye and skin complaints
Pulmonary - pulmonary vessels are NOT affected in PAN (‘P’ulmonary vessels ‘A’re ‘N’OT affected, so PAN)
PAN - what are the investigations?
Hepatitis B serology positive in 30% of patients
Diagnosis challenging as features not distinguishable from other diseases
Diagnosis based on symptoms described, physical examination, lab tests (to exclude other causes)
Possibly biopsy of the affected area