MSK: Part 4 Flashcards
What are all vasculitis associated with
Anaemia and raised ESR
What conditions are associated with vasculitis
Infective: 1. Subacute infective endocarditis Non-infective: 1. Vasculitis with RA 2. SLE 3. Scleroderma 4. Polymyositis/Dermatomyositis 5. Good pasture syndrome and UC/Crohn's
What patients are effected by Polymyalgia Rheumatica and Giant Cell Arteritis (large vessel vasculitis)
Patients older than 50
What is associated with PMR and GCA
Finding of GCA on temporal artery biopsy (THEY COEXIST)
What is giant cell arteritis
Arteries of the head and neck inflame
What gender is effected by Polymyalgia Rheumatica
FEMALES
Risk factors of Polymyalgia Rheumatica
- SLE
2. Polymyositis/dermamyositis
Clinical presentation of Polymyalgia Rheumatica
- Sudden onset of severe pain and stiffness of the shoulders and neck, and of the hips and lumbar spine; a limb girdle pattern
- Symptoms are worse in the morning, lasting from 30 mins to several hours
- Mild polyarthritis of peripheral joints
- 1/3rd experience: fatigue, fever, weight loss, depression
Differential Diagnosis of Polymyalgia Rheumatica
- RA, spondyloarthropathies, SLE, polymyositis
- Osteoarthritis, malignancy
- Chronic pain syndrome (fibromyalgia and depression)
Diagnosis of POlymyalgia Rheumatica
- ALWAYS over 50
- ESR and CRP RAISED
- ANCA negative
- Serum alkaline phosphatase raised
- Normochromic, normocytic anaemia present
- Giant cell arteritis upon temporal artery biopsy
What FBC content is used to distinguish polymyalgia Rheumatica from myositis
Creatinine Kinase is normal
How is Polymyalgia Rheumatica treated
- CORTICOSTEROIDS (reduce symptoms of PMR) - ORAL PREDNISOLONE
- If improvement does not occur then diagnosis should be questioned
- Decrease SLOWLY
- Used long-term to give GI and bone protection (e.g. LANSOPRAZOLE, ALENDRONATE and Ca/vit D)
What is Giant cell arteritis
Inflammatory granulomatous arteritis of large CEREBRAL ARTERIES as well as large vessels associated with PMR
Risk factors for giant cell arteritis
- Over 50
- Female
- RA, SLE, scleroderma
What happens to arteries in Gaint cell arteritis
- Arteries become inflamed, thickened and obstruct blood flow
What arteries are effected in giant cell arteritis
- Cerebral arteries (temporal artery) and ophthalmic artery = temporary vision loss)
Clinical presentation of giant cell arteritis
- Temporal pulsations (headaches)
- Tenderness of scalp or temple
- Claudication of the jar when eating (pain)
- Tenderness and welling of one or more temporal or occipital arteries
- Sudden painless vision loss (arteritis anterior ischaemic optic neuropathy - optic disc is very pale)
- Malaise, lethargy, fever
- Associated symptoms of PMR
- Dyspnoea, morning stiffness and unequal pulses
Morning Stiffness Does Seem Very Convenient This Hour
Differential diagnosis of giant cell arteritis
- Migraine
- tension headache
- Trigeminal neuralgia
- Polyarteritis nodosa
The Magnus Nasty Neil
Diagnostics of Giant cell arteritis
- Over 50
- New headache
- Temporal artery tenderness
- ESR raised
- Abnormal artery biopsy (inflammatory infiltrates present)
ONE OF 3
AND TEMPORAL ARTERY BIOPSY
FBC tests for Giant Cell arteritis
- ESR raised
- Normochromic, normocytic anaemia
- ANCA negative
- CRP VERY HIGH
- Serum alkaline phosphatase RAISED
When should temporal artery biopsy be done for giant cell arteritis
- BEFORE or within 7 days of starting high dose
2. Lesions are patchy so take a big chunk
Histological features of Giant cell arteritis
- Cellular infiltrates of CD4+ T cells, macrophages and giant cells in the vessel wall
- Granulomatous inflammation of the intima and media
- Breaking up of internal elastic lamina
Treatment of Giant cell arteritis
- PREDNISOLONE to stop vision loss
- Long-term to protect GI and bones (LANSOPRAZOLE, ALDENRONATE and Ca/Vit D)
- Monitor treatment progress by looking at fall in ESR/CRP
Name two medium-vessel vasculitis
- POLYARTERITIS NODOSA
2. CRYSTAL ARTHROPATHIES