Polymyalgia Rheumatica and GCA Flashcards

1
Q

What is PR?

A

Inflammatory condition that causes pain and stiffness in shoulders, pelvic girdle and neck

Large vessel vasculitis

Strong association with GCA

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2
Q

What are the risk factors for PR?

A

Age >50
Female
Caucasian ethnicity

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3
Q

What are the symptoms of PR?

A

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
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4
Q

What are the signs of PR?

A

Muscles tender to palpate esp in upper arm

Muscle wasting

Muscle weakness in upper and lower proximal regions

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5
Q

How is it diagnosed?

A

Symptoms must be present for >2wks
Symptoms of bilateral shoulder or pelvic girdle pain
Morning stiffness

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6
Q

What are differentials?

A
SLE
OA
RA
Myositis
Osteomalacia
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7
Q

What investigations are needed?

A

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

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8
Q

What is the management?

A

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

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9
Q

What is GCA?

A

Systemic vasculitis of medium and large arteries

Typically presents with symptoms affecting temporal arteries

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10
Q

What are the symptoms of GCA?

A
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
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11
Q

What are the signs of GCA?

A
Tenderness/swelling of one/both temporal arteries
Overlying scalp inflammation
Reduced/absent temporal pulse
Poor visual acuity
Swollen optic disc on fundoscopy
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12
Q

How is GCA diagnosed?

A

Based on

  • Clinical presentation
  • raised ESR
  • Temporal artery biopsy findings- multinucleated giant cells found
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13
Q

What other investigations are needed for GCA?

A

FBC- normocytic anaemia and thrombocytosis
LFTs- raised ALP
CRP- raised
Duplex USS of temporal artery shows hypoechoic halo sign

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14
Q

What is the management of GCA?

A

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

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15
Q

What are measures that are needed for long term steroid use?

A

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

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