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RB Y2 MSK 02 - Rheumatology > Muscle Disease: Polymyalgia Rheumatica > Flashcards

Muscle Disease: Polymyalgia Rheumatica Flashcards

1
Q

polymyalgia rheumatica

A

chronic inflammatory condiiton of unknown aetiology that affects elderly individuals (rarely seen under the age of 50)

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2
Q

where is incidence higher

A

norther regions

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3
Q

who does it tend to affect

A

elderly individuals - >50

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4
Q

presentation

A
  • pain in the shoulder and hip girdle
  • morning stiffness
  • Mild polyarthritis, tenosynovitis and carpal tunnel syndrome
  • There may be associated fever, weight loss, anorexia and depression
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5
Q

describe the distribution of symptoms

A

usually symmetrical

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6
Q

how do symptoms progress over the course of the day

A

tend to improve and also with movement

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7
Q

what problems may patients describe with their morning stiffness

A

difficult to get out of bed in the morning

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8
Q

is weakness a feature

A

no

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9
Q

length of onset

A

subacute - <2 weeks

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10
Q

differential diagnoses

A
  • Sudden onset RA
  • Polymyositis
  • Hypothyroidism
  • Primary muscle disease
  • OA
  • Occult malignancy or infection
  • Bilateral subacromial impingement
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11
Q

GCA

A

a form of systemic vasculitis, causes granulomatous arteritis of the large vessels

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12
Q

GCA histology

A

transmural inflammation of affected arteries, and patchy infiltration by lymphocytes, macrophages and multinucleated giant cells

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13
Q

how does ischaemia occur in GCA

A

vessel wall thickening and subsequent arterial luminal narrowing

results in distal ischaemia

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14
Q

presentation of GCA

A

headache

visual disturbances - amaurosis fugax

scalp tenderness

tender, enlarged non pulsatile arteries

jaw claudication

fatigue, malaise, fever

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15
Q

what is amaurosis fugax

A

painless temporary loss of vision in both eyes

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16
Q

what should be consider as a DD if patient presents with GCA but it under 50

A

Takayasu’s arteritis

17
Q

what should be done if GCA is suspected

A
  • ESR
  • start 60mg prednisolone immediately
  • the risk is irreversible bilateral blindness
18
Q

describe the headache in GCA

A

continuous

located in temporal or occipital areas

19
Q

amaurosis fugax

A

painless temporary loss of vision in both eyes

sign of poor blood supply to optic nerve

permanent loss of vision occurs in 20% patients

20
Q

what are the arteries like in GCA

A

tender, enlarged and non pulsatile

21
Q

what can GCA result in in the arteries

A
  • Can result in arteritic anterior ischaemic optic neuropathy (occlusion of optic nerve head circulation due to inflammation of posterior ciliary arteries)
  • This results in sudden, profound visual loss, and irreversible bilateral blindness
22
Q

what is one of the most significant causes of morbidity in GCA

A

visual loss - permanent in 20% patients

23
Q

jaw claudication in GCA

A
  • result of ischaemia of the maxillary artery
  • Fatigue or discomfort of the jaw muscles during chewing of firm foods or prolonged speaking
24
Q

when should GCA be considered

A

new onset headache in patient >50 with an elevated ESR, CRP or PV

25
Q

diagnosis of PR and GCA

A
  • diagnosis of exclusion
  • raised inflammatory markers - ESR, PV, CRP
26
Q

which is the most useful blood test

A

ESR

27
Q

what is the most definitive test for GCA

A

temporal artery biopsy

  • due to patchy involvement of artery, low sensitivity
28
Q

CK levels

A

normal - distinguishing feature from PM and DM

29
Q

what will a temporal artery biopsy show

A

mononuclear infiltration or granulomatous inflammation

multinucleated giant cells

30
Q

treatment

A

Expect a rapid and dramatic response to steroids within one week, if not consider a DD

31
Q

steroid doses

A

prednisolone 15mg OD for PR

prednisolone 40mg OD for GCA

32
Q

when should steroids be started

A

as soon as diagnosis made

33
Q

maintenance of treatment

A
  • The prednisolone dose is reduced gradually over around 2 years. For the majority of patients, the condition will resolve over this period. Most need steroids for ≥2 years, so give gastric and bone protection
    • Side effect of peptic ulceration – prescribe PPI, e.g. omeprazole
    • Bisphosphonates, e.g. alendronate
34
Q

role of NSAIDs and steroid sparing agents

A

there is no role

35
Q

what must you tell patients (safety netting)

A
  • Inform patients to seek urgent review if symptoms of GCA develop.
  • GCA can lead to absolute blindness through bilateral central retinal artery occlusions or severely reduced vision with an anterior ischaemia optic neuropathy

RB Y2 MSK 02 - Rheumatology (33 decks)

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