MSK and Rheum - Polymyalgia Rheumatica, Temporal Arteritis, Polyarteritis Nodosa Flashcards

1
Q

Polymyalgia Rheumatica - what is it?

A

Condition characterised by muscle stiffness and raised inflammatory markers

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2
Q

Polymyalgia Rheumatica - who does it affect and how quickly?

A

Commonly >60yo

Rapid onset <1 month

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3
Q

Polymyalgia Rheumatica - what are the clinical features?

A

MORNING STIFFNESS in proximal limb muscles

Weakness is NOT considered a symptom

Low-grade fever, night sweats

Polyarthralgia

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4
Q

Polymyalgia Rheumatica - what are the investigations and the associated blood product levels?

A

Rasided inflamm markers = ESR >40mm/hr

Creatine Kinase (CK) = NORMAL, way to differentiate from other disorders

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5
Q

Polymyalgia Rheumatica - management?

A

PREDNISOLONE 15mg OD

Patients should respond dramatically to steroids - so if they don’t consider diff diagnosis

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6
Q

Temporal Arteritis - what is it?

A

It is a large vessel vasculitis

Overlaps with polymyalgia rheumatica

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7
Q

Temporal Arteritis - what are the overlapping features with PMR?

A

Older people >60yo

Rapid onset <1 month

Clinical features - 50% have features of PMR:
1. Morning stiffness, but not weakness

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8
Q

Temporal Arteritis - what are the clinical features?

A
  1. Morning stiffness in proximal limb muscles, but NOT WEAKNESS
  2. VISUAL DISTURBANCES - double vision, amaurosis fugax, blurring
  3. Headache
  4. Jaw claudication
  5. Tender, palpable temporal artery
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9
Q

Temporal Arteritis - what are the investigations and what would you see?

A

Bloods:
1. Inflamm markers RAISED = ESR >50mm/hr

  1. Temporal artery biopsy - SKIP LESIONS PRESENT
  2. VISION TESTING - results changes initial management step
  3. CK = NORMAL, like in PMR
  4. EMG = normal
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10
Q

Temporal Arteritis - management?

A

Urgent glucocorticoids given before biopsy, as soon as TA suspected:

  1. If NO vision disturbances = high-dose prednisolone
  2. If there IS visual disturbances = IV methylprednisolone given first, then high-dose prednisolone
  3. Same day ophthalmology review
    - Consider giving bisphosphonates as patient on long-term course of steroids (risk of osteoporosis)
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11
Q

Polyarteritis Nodosa (PAN) - what is it?

A

It is a vasculitis affecting medium sized arteries with necrotizing inflammation leading to aneurysm formation

Affects many organs

Associated with HepB

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12
Q

PAN - what is the characteristic disease it is associated with?

A

HepB

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13
Q

PAN - when does it present?

A

Presents more in men, aged 40-60yo

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14
Q

PAN - what are the clinical features?

A

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)

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15
Q

PAN - what are the investigations?

A

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

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16
Q

PAN - management?

A
  1. Corticosteroid therapy
  2. If relapse whilst on corticosteroids, add cyclophosphamide
  3. Maintenance therapy - azathioprine