PMR + GCA Flashcards
PMR and GCA are common ? diseases of the ?, both types of large vessel ? that are associated with the finding of giant cell arteritis on ? artery biopsy;
15-30% of patients with ? will develop ? .
50-70% of patients with ? will develop ?.
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PMR
Presentation;
o Patient always >?.
o ? onset severe pain and ? in the ?, ?, ? and ? spine.
o Worse in the ?, lasting for ? 30 minutes.
o Systemic features of tiredness, ? and ? ?.
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PMR
The arterial inflammation is generally ?, with the pain and stiffness due to ? and peri-? inflammation.
On examination, muscles may be ? to palpate, especially in the ? ? (e.g. when measuring ?).
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PMR
Symptoms of ? shoulder/ pelvic girdle ? (or both) alongside ? stiffness and evidence of an ? ? response must be present for over ?weeks for diagnosis to be made.
After diagnosis has been made, it is essential to assess for ?.
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GCA
Often will report concurrent symptoms of PMR, but can occur alone.
Symptoms;
o Severe ?.
o ? (when combing hair) or ? tenderness.
o ? ? whilst eating.
Symptoms are due to ? vasculitis of the medium and large arteries.
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GCA
On examination there may be tenderness / ? of one or both ? arteries. The overlying ? may be inflamed.
Untreated there will be sudden ? loss of ? due to ischaemia of the ? nerve.
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Investigations; ?cytic ?chromic anaemia. ? ESR / CRP. Often raised ?/? on LFTs. ?/?/anti-? negative. CK ?. MRI/ USS will show evidence of peri-? inflammation (?/tenosynovitis) in PMR.
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If there are features of GCA, a ? artery ? should also be taken (although often not performed in practice) as a definitive diagnostic test;
? hypertrophy, with ? cells and ? infiltrate.
? lesions occur, so ? biopsy does not exclude the diagnosis.
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Management;
Oral ?, ? dose initially, to reduce the risk of permanent ? damage in GCA, and reduce the risk of ? developing in PMR;
o PMR: ?mg o.d.
o GCA: ?mg o.d. if ?symptoms, ?mg o.d. if no ? symptoms.
• Refer to ? on the same day if visual symptoms.
• 80 mg o.d. if there is ? of ? in one ?.
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Mx
Response to steroids is usually ?, and consideration of an alternative diagnosis should occur if there is no response in ? hours.
Dose reduction occurs over a ? time in line with disease response, and determined by regular ?/? levels.
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long
esr/crp
Mx
Most PMR patients require treatment for two ?, with maintenance therapy advised in ? for up to ? years;
o Always prescribe ? ? and ???s.
Patients with GCA should also be monitored for ?/ large vessel involvement (??? or aortic root ?), which can complicate the disease
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