PMR, GCA, & TA

Question 1

A 72 yo female presents with symmetric proximal muscle pain and stiffness. It is mostly in her shoulder girdle, but she has some aching and stiffness in her hips. She says the pain is worse in the morning. Exam reveals normal ROM and muscle strength, soft tissue swelling of her wrists, and LE edema. What do you suspect? What is the underlying etiology?

Answer 1

Polymyalgia Rheumatica

Systemic inflammatory disorder

Question 2

A 80 yo female presents with aching and stiffness. Exam is normal. What might you suspect? What labs should you order and what do you expect?

Answer 2

Polymyalgia Rheumatica
No specific labs
Elevated ESR, AP, CRP
Normal CK

Question 3

A 75 yo female presents complaining of aching and stiffness in her neck and shoulder area. She has recently noticed weight loss, fever, and malaise. PE shows normal ROM & muscle strength. What treatment should you recommend for symptom relief?

Answer 3

Polymyalgia Rheumatica

Prednisone

Question 4

A 68 yo female presents with aching and stiffness despite a normal PE. You suspect PMR. What treatment options should you recommend?

Answer 4

Corticosteroids (1st line): Prednisone
Immunosuppressants (avoid)
Biologic therapy (avoid)

Question 5

A 74 yo female presents with HA, jaw claudication, PMR, and fever. She came in today because she had an episode of amarosus fugax followed by diplopia. What do you suspect? What complications are you worried about?

Answer 5

Giant Cell Arteritis
Stroke
Aneurysm
Visual complications/loss

Question 6

A pt presents with HA, jaw claidcation, amarosus fugax, cough, sore throat, and tongue pain. Exam reveals unequal BPs between her arms. What labs should you order?

Answer 6

GCA
ESR, CRP, AP
WBC for thrombocytosis

Question 7

A pt presents with HA, jaw claudication, tongue pain, leg claudication, and constitutional sx. What treatment should you recommend for this pt?

Answer 7

GCA
REFER ASAP
Prednisone (1st line)
ASA

Question 8

A pt presents with an abnormal appearing temporal artery on exam. You also find asymmetric BPs, bruits, and murmurs of aortic insufficiency. What is the underlying pathophys behind this pts condition?

Answer 8

Temporal arteritis (TA)
GCA affecting occipital, temporal, facial, lingual, and/or external carotid arteries

Question 9

A pt presents with an abnormal appearing temporal artery. You suspect TA. What labs should you run? What definitive diagnostic test should you perform?

Answer 9

ESR, CRP, AP

Temporal artery biopsy

Question 10

A pt presents with an abnormal temporal artery and asymmetric BPs. On exam you hear bruits and a murmur. How should you treat assuming biopsy confirms your suspected diagnosis?

Answer 10

TA
Prednisone (1st line)
ASA