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Joints, bones and skin > Polymyalgia rheumatica > Flashcards

Polymyalgia rheumatica Flashcards

1
Q

What medication rapid response to in PMR

A

Corticosteroids

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2
Q

Where does PMR classically cause pain

A

Stiffness in shoulder and pelvic girdles

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3
Q

How differentiate between myositis and PMR

A

Reduced muscle strength in myositis

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4
Q

What condition od 15% of PMR patients develop

A

Giant cell arteritis

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5
Q

Who does PMR present

A

> 50 years
70-80 most common
3 x more in women

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6
Q

Cause of PMR

A

Environmental factors and genetics
HLA-DRB104 and -DRB101 alleles have been observed, which may increase susceptibility to developing PMR.

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7
Q

Onset of PMR

A

Subacute - 2-6 weeks

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8
Q

Shoulder features in PMR

A

Tenderness, bursiitis, ROM - localise to neck muscles tenderness

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9
Q

Systemic sympotms in PMR

A

Low grade fever, fatigue, anorexia, weight loss, depression

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10
Q

Features of PMR

A

Shoulder and pelvic girdle pain
Rapid response to steroids
Systemic symptoms - low grade fever, fatigue, anorexia, weight loss depression
Peripheral oligarticular arthritis - wrist, knees, MCPs

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11
Q

What would suggest presentation is not PMR

A

<50 years
Normal inflammatory markers

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12
Q

What red flags need to screen for in PMR

A

Paraneoplastic syndrome -
-Resp, urinal haema nd GI systems

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13
Q

What can delayed presentation of polymyalgia rheumatica cause

A

Muscle wasting

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14
Q

Referral guide for PMR to secondary care

A

<60 years
Red flags of serious pathology incl weight loss, night pain or neuro
Dont have core features eg bilateral shoulder/pelvic girdle pain #>45 mins morning stiffness
Unusual features PMR - normal or v high inflam markers
Chronic onset of symptoms
Limited repsonse to steroids

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15
Q

Why can RA be confused for PMR

A

Initial phase can present similarly to PMR - synovitis or clinical features of RA -. refer for RA

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16
Q

Signs of GCA

A

Headache, jaw claduciation, visual disturbance

17
Q

PMR steroid trematne t

A

Prednisolone 15mg OD
Weaned off gradually dose adjust every 4-8 weeks
Review one week after each adjustment
If frequent relapses or higher risk from adverse effect of steroids - DMARD - methotrexate
Toclixumab - 3rd line

18
Q

Risks of corticosteroids

A

Osteoporosis
Increased risk of infection
#T2DM
HPTN
Cataract
Glaucoma
#Skin changes - thinning, bruising

18
Q

Complications of GCA

A

Permanent vision loss

19
Q

Factors increasing risk of relapse

A

Female sex
High inflam markers
Peripheral arthritis

19
Q

Course of steroids prognosis

A

Paitents will relapse at some point
On steroids for 2-3 years

20
Q

WHat is GCA

A

Vasculitis of medium and large vessels occuring i over 50s

21
Q

Why si prompt treatment in GCA vital

A

Prevent permanent vision loss

22
Q

GCA features

A

Rapid onset <1 months
Headache
Jae claudication
Vision eg amourosis fugax, diplopia
Tender, palpable temporal artery
PMR symptoms
Lethargy, depression, low grade fever, night sweats

23
Q

wHAT IS CAUSE OF MAJORITY OF OCULAR COMPS IN gca

A

anterior ischemic optic neuropathy - Occlusion of posterior ciliary artery ->ISCHAEMIA OF OPTIC NERVE HEAD

24
Q

Fundoscopy of anterior ischemic optic neuropathy

A

Swollen pale disc + blurred margins

25
Q

Diagnosis of GCA criteria

A

3 or more of:
>50 years
New onset of headache
Temporal artery abnormality - tenderness, thuckened or reduced pulsation
ESR>50
Abnormal artery biopsy
Changes consistent with GCA on biopsy

26
Q

Investigations for GCA

A

ESR>50
CRP
Temporal artery biopsy - skip lesions
CK and EMG - normal

27
Q

Investigations for low clinical probability of GCA

A

Tmeporal axillary artery US - if postiive biopsy to diangosie within 14 dyas of steroids

28
Q

Medium vs high clinical probability of temporal arteritis

A

US prior to biopsy
High - US is sifficent alone to diagnose

29
Q

Central retinal artery occlusion on fundoscopy

A

Cherry red spot with retinal awhiteneing

30
Q

When should high dose steroids be used GCA

A

As soon as diagnosis suspected - before artery biopsy

31
Q

What steroids are used visual loss vs none

A

No visual loss - oral pred
Evolving visual loss - IV methylprednisolone prior to oral pred
Should be a dramatic response

32
Q

What need to give along steroids in GCA

A

Bisphosphonates due to long course of steroids
Low dose aspirin

33
Q

Complications of GCA

A

Visual loss - anterior ischaemic optic neuropathy
Ocular comps eg retinal artery occlusion, diplopia, ptosis
Stroke
Aortic aneurysm and dissection
Large cessel involvement - axillary, vertebral, SC, cranial -> limb claduaication, ishcaemia, vertebrobasilar insufficiency
PMR
Systemic symptoms

34
Q

Long term steroids use risks

A

Osteoporosis
Diabteets
HPTN
Increased infection susceptibility

Joints, bones and skin (31 decks)

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