Polymyalgia Rheumatica and Giant cell Arteritis Flashcards
what % of Polymyalgia rheumatica patients develop giant cell arteritis and vice versa
PMR to GCA = 15-30%
GCA to PMR = 50%
whats the pathology for polymyagia rheumatica
Mild, non-erosive synovial and periarticular inflammation of proximal joints
In some patients sub-clinical arterial inflammation is evident
This leads to Intense muscle pain and stiffness of joints
Shoulder and pelvic girdle most commonly affected
whats the pathology for Giant cell/temporal arteritis
Inflammatory infiltrative accumulates in medium and large arteries
Results in granulomatous vasculitis
Vessel wall injury, luminal occlusion and vascular stenosis
Leading to ischaemia
what are the diagnostic criteria for PMR
> 50
> 2 weeks
Bilateral shoulder or pelvic girdle aching, or both
Purely pelvic girdle involvement is much less likely
Morning stiffness duration of >45 mins
Evidence of an acute phase response (fever, W/L)
if polymalgia rheumatica is diagnosed what must be assessed immediately afterwards
GCA/temporal arteritis
what are some differntials for proximal girdle pain
Multiple myeloma Rheumatoid arthritis Late onset spondyloarthritis CTD:SLE Polyarticular calcium pyrophosphate deposition disease Muscle disease Cervical spondylosis Leukaemia Hypothyroidism Fibromyalgia Paraneoplastic syndrome MSK issues Osteomalacia Infections – bacterial endocarditis Parkinsons Osteomyelitis
what investigations are typically done in polymyalgia rheumatica
Bloods ESR (raised) CRP (raised) FBC (normochromic/normocytic anaemia) Platelets (may be raised) Rheumatoid factor, ANA, anti-CCP negative
Scans
US/MRI
Peri-articular inflammation
X-ray
Good to do as a screen to check for chest malignancies/Tb which can cause a similar presentation as outlined earlier
what is polymyalgic onset of rheumatoid
RA presents as PMR atypically instead of the normal fashion
what is a rule of thumb when someone is admitted with a pyrexia of an unknown cause
1/3 will have malignancy, 1/3 sepsis, 1/3 autoimmune disease
how do you manage polymyalgia rheumatica
prednisolone - 15mg for 2 weeks then reduce by 1mg for 4-6 weeks when weaning off to get to maintenance dose of 5-7mg/day for 6 months. reduce the maintenance by 1mg every 6-8 weeks + attempt withdrawal by 18 months - 2 years of treatment
supplement with PPI + bisphosphonate + Vit D + Calcium
what are side effects of treatment for polymyalgia rheumatica (side effects of steroids)
Weight gain Skin atrophy Oedema Increased IOP Cataracts GI distrubance Diabetes Osteoporosis
when should you consider specialist referral for polymyalgia rheumatica
<60 Chronic onset Lack of shoulder involvement Lack of inflammatory stiffness RED FLAGS Suspect other rheumatology condition Poor response Need for prolonged steroids Contra-indications to steroid use
what is the average treatment length for polymyalgia rheumatica
3 years
what are clinical features of giant cell arteritis/temporal arteritis
Abrupt onset new Headache
Tenderness in scalp - Can be a 9/10 on pain scale
Altered vision (15%) Pain Visual blurring Transient loss of vision Visual hallucinations Diplopia Blurring (from optic neuritis) Amarurosis figax 15% of patients have optic nerve ischaemia
Jaw/tongue claudication (50%)
Nodular swellings
Poor pulsation
Weight loss, fever, malaise
Rarer ones Scalp necrosis Cranial nerve palsy Limb claudication Systemic s+s
what are complications for giant cell arteritis/temporal arteritis
blindness
Stroke
Inflammatory aortitis - may develop AAA
