November 23, 2015 - Pain Between Joints

Question 1

Polymyalgia Rheumatica

Answer 1

A syndrome with pain or stiffness usually in the neck, shoulders, upper arms, and hips. Usually occurs in adults over 50 years old and they experience stiffness with rest (gelling). Can be unable to raise arms or stand up from a seated position.

This may be the presenting feature of RA or may be associated with temporal arteritis.

Question 2

Polymyalgia Rheumatica - Treatment

Answer 2

Prednisone 30-40mg per day

Reduce dose when ESR returns to normal

Question 3

Temporal Arteritis

Answer 3

Also known as Giant-cell arteritis (GCA).

Inflammatory disease of the blood vessels most commonly involving the large and medium arteries of the head, predominantly the branches of the external carotid artery. The most serious complication is occlusion of the ophthalmic artery which can cause blindness.

Biopsy is important. It often skips areas.

Question 4

Temporal Arteritis - Treatment

Answer 4

Prednisone is the primary treatment. 40-60mg daily and it will usually clear up within 24-48 hours.

Question 5

Overuse Conditions

Answer 5

Muscular and ligamentous pain in individuals who repeat motions over and over again. This could be at work, or through sports.

Question 6

Fibromyalgia

Answer 6

A chronic pain disorder characterised by chronic widespread pain and a heightened and painful response to pressure. There are typically 18 tender points on the body.

Affects women 8-9x more often than men, and most commonly in the 40-50 age group.

Also presents with a multitude of other symptoms sometimes such as muscle pain, abdominal pain, IBS, dizziness, muscle weakness, memory loss, blurring of vision, shortness of breath, cold hands/feet, dry eyes/mouth, seizures, rash, sun sensitivity and more.

Pathophysiology seems to be hyperexcitability of nerves.

Question 7

Fibromyalgia - Treatment

Answer 7

The 4 E’s

1. Evaluation (right diagnosis)
2. Education (more power)
3. Exercise (helps with symptoms)
4. mEdications