Polymyalgia Rheumatica and GCA Flashcards
Where does Polymyalgia cause pain?
Pelvic girdle
Shoulders
What are core features of PMR?
Bilateral shoulder pain that radiates to elbow Worse on movement Bilateral pelvic girdle pain Sleep disturbed Low mood Pitting oedema Carpal tunnel Stiffness for at least 45 mins in morning
PMR differentials?
OA RA SLE Myositis Spondylosis Fibromyalgia
How his PRM diagnosed?
Clinical presentaiton and response to steroids
Diagnosis of exclusion besides that
How is PMR managed?
Prednisolone
Assess after 1 week and at 3-4 weeks (start reducing dose if good response)
What measures must be taken for patients on long term steroids?
DONT STOP
DON’T- stopping once htey’ve been on for 3 weeks risks adrenal crisis
S-sick day rules
T- treatment card to alert others
O- osteoporosis risk so consider bisphosphonates, Ca and Vit D
P-PPI needed
How does GCA present?
Severe unilat headache Pain chewing Carotid bruits Hard non pulsatile artery Scalp tenderness Jaw claudication Blurred/double vision \+/- systemic symptoms
How is GCA diagnosed?
Raised ESR >50mm/hour or more
Temporal artery biospsy findinds (giant mutlinucleated cells)- often negative due to skip lesions
Also-
CRP high, alk phos high, anaemia and thrombocytosis
Duplex ultrasound of temporal artery shows HYPOECHOIC HALO sign
How is GCA managed?
If visual signs IV methylpred same day otherwise
40 mg pred (60 if jaw claudication or eye) before confirmed
Aspirin 75mg
PPI
Rerfer to vascular surgeons for biopsy
Refer to opthalmology is visual symptoms
What are complications of GCA?
Vision loss
Stroke
Relapses (common)
Aortitis leading to aortic dissection
How long does GCA last for?
Approx 1 year. Aim is to keep ESR and CRP normal for age in this time
