Polymyalgia and giant cell arteritis Flashcards
What are the different types of vasculitis?
Large cell
- Takayasu arteritis
- Giant cell
Median cell
- Polyarteritis nodosa
- Kawasaki disease
Immune complex small vessel
- Cryoglobulinaemic
- IgA (henoch-schonlein)
- Hypocomplementemia urticarial
ANCA-associated
- microscopic polyangitis
- Wegener’s
- Churg-strauss
What is polymyalgia rheumatica?
Most common rheumatic disease in older people
- Characterised by pain and morning stiffness in the neck shoulder, and pelvic girdle muscles
Cause unknown but responds to steroids
Who is at the highest risk of polymyalgia rheumatica?
- Higher risk with age (peak at 70-80yrs)
- Female sex
- Northern European ancestry
How is polymyalgia rheumatica diagnosed?
Using the BSR (British society for rheumatology) and BHPR (British health professionals in rheumatology) diagnostic criteria
- Age > 50 years
- Duration > 2 weeks
- Bilateral shoulder or pelvic girdle ache
- Morning stiffness duration of > 45 minutes
- Acute phase response (ESR and CRP)
What are the features of polymyalgia rheumatica?
- Systemic: fever, fatigue, anorexia, weight loss, depression
- Peripheral arthritis?
- Morning stiffness
- Hip, neck and upper arm pain/tenderness
Muscle strength not impaired
What is fibromyalgia?
A chronic condition that causes pain all over the body
What are some differentials for polymyalgia rheumatica?
- Degenerative disorder: Spondylosis, rotator cuff disorders, capsulitis
- Inflammatory disorders: Rheumatoid arthritis, myositis
- Endocrine: hypothyroidism
- infections: TB, endocarditis
- Cancer: myeloma, lymphoma
- Drug: statins
- Neuro: Parkinson’s
- Other: fibromyalgia
How is polymyalgia rheumatica managed?
- Low dose oral prednisolone (15mg daily), response should be dramatic
- Consider methotrexate
- Ensure bone protection (bisphosphonates or calcium+ vit D)
- Monitor CRP with regular follow up
What are atypical features that may suggest polymyalgia rheumatics is not the diagnosis?
- No response to steroids
- Age <60 yrs
- Chronic onset
- Lack of shoulder involvement or inflammatory features
- Predominant systemic features likes weight loss and night sweats
What are the clinical features of giant cell arteritis?
- Constitutional: fever, anorexia, sweats, fatigue, weight loss, polymyalgia
- Sudden and severe headache, classically temporal
- Scalp tenderness
- Jaw/ tongue claudication
- Eye symptoms: visual loss, temporary curtains over vision
- Superficial artery tenderness, redness, and pulseless
What are the differentials for giant cell arteritis?
- Herpes zoster
- Migraine
- Intracranial pathology
- cluster headache
- Sinus disease
- Ear disease
- temporomandibular joint pains
What is the treatment for giant cell arteritis?
URGENT: visual loss - give 500mg-1g IV methylprednisolone for 3 days
- 40-60mg oral prednisolone daily
- Slowly decrease steroids over 12-18 months if there are no more symptoms
