Polymyalgia Rheumatica and GCA Flashcards
What is PR?
Inflammatory condition that causes pain and stiffness in shoulders, pelvic girdle and neck
Large vessel vasculitis
Strong association with GCA
What are the risk factors for PR?
Age >50
Female
Caucasian ethnicity
What are the symptoms of PR?
Sudden/insidious onset
Severe pain/stiffness in neck, shoulders, hips and lumbar spine
Worse in the morning lasting >30mins
Worse on movement
Often bilateral
Interferes with sleep
Systemic features
- tiredness
- fever
- weightloss
Can also get
- pitting oedema
- carpal tunnel syndrome
- upper arm tenderness
What are the signs of PR?
Muscles tender to palpate esp in upper arm
Muscle wasting
Muscle weakness in upper and lower proximal regions
How is it diagnosed?
Symptoms must be present for >2wks
Symptoms of bilateral shoulder or pelvic girdle pain
Morning stiffness
What are differentials?
SLE OA RA Myositis Osteomalacia
What investigations are needed?
Lots to rule out other conditions
Bloods
- FBC
- U&Es
- LFTs
- Calcium- hyperparathyroidism (high) or osteomalacia (low)
- TSH
- CK- for myositis
- Rheumatoid factor- RA
- ANA- for SLE
- Anti-CCO- for myeloma
Urine dip
CXR for lung and mediastinal abnormalities
What is the management?
Initially 15mg prednisolone/day
Assess 1wk later
-if no response=unlikely PR so stop steroids
If improvement reassess after 3/4wks
- inflam markers should return to normal and 70% improvement in symptoms
- start to reduce dose
If symptoms reappear then increase dose or stay on the same dose for longer before reducing
What is GCA?
Systemic vasculitis of medium and large arteries
Typically presents with symptoms affecting temporal arteries
What are the symptoms of GCA?
Severe unilateral headache Scalp tenderness- when brushing hair Jaw claudication Blurred/double vision Irreversible painless sightloss can happen quickly
Systemic features
- fever
- fatigue
- weight loss
- muscle aches
What are the signs of GCA?
Tenderness/swelling of one/both temporal arteries Overlying scalp inflammation Reduced/absent temporal pulse Poor visual acuity Swollen optic disc on fundoscopy
How is GCA diagnosed?
Based on
- Clinical presentation
- raised ESR
- Temporal artery biopsy findings- multinucleated giant cells found
What other investigations are needed for GCA?
FBC- normocytic anaemia and thrombocytosis
LFTs- raised ALP
CRP- raised
Duplex USS of temporal artery shows hypoechoic halo sign
What is the management of GCA?
Start on steroids immediately before confirming diagnosis
40-60mg prednisolone/day
- 60mg if jaw claudication or visual symptoms
- 40mg- if none
- review in 48hrs
Response to treatment is normally rapid
Gradually decrease over time
Aspirin 75mg daily decreases visual loss and strokes
What are measures that are needed for long term steroid use?
Don’t STOP
Don’t-
-become steroid dependent after 3 weeks so do not suddenly stop- must taper dose down
S-sick day rules
-increase steroid dose if unwell
T- treatment card
-to alert others they are steroid dependent
Osteoporosis prevention
-need prophylactic bisphosphonates, calcium and VitD
PPI
-for gastric protection