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MSK > Polymyalgia Rheumatica + GCA > Flashcards

Polymyalgia Rheumatica + GCA Flashcards

1
Q

What is Polymyalgia Rheumatica?

A

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

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2
Q

Who is usually affected by polymyalgia?

A

Older adults
Women
Caucasians

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3
Q

What are the core clinical features of polymyalgia?

A

Bilateral shoulder pain that may radiate to the elbow
Bilateral pelvic girdle pain
Worse with movement
Interferes with sleep
Morning stiffness for at least 45 minutes

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4
Q

What are the differentials for polymyalgia?

A

OA
RA
SLE
Myositis
Cervical spondylosis
Frozen shoulder (adhesive capsulitis) of both shoulders
Hyper/hypothyroidism
Osteomalacia
Fibromyalgia

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5
Q

What investigations are carried out for polymyalgia?

A

FBC, U&Es, LFTs, TFTs, ESR, CRP
Calcium
Creatine kinase
RF and anti-CCP

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6
Q

How is polymyalgia diagnosis confirmed?

A

Clinical presentation and response to steroids

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7
Q

What is the treatment regime for polymyalgia?

A

15mg of prednisolone
Assess 1 week after starting steroids
Assess 3-4 weeks after- should be 70% improvement in symptoms
Start a reducing regime

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8
Q

What is DONT STOP in patients on long term steroids?

A

DONT- do not abruptly stop as this may cause adrenal crisis
Sick day rules- increase steroid does if they become unwell
Treatment card- alerts others that they are steroid dependent
Osteoporosis- prophylaxis with bisphosphonates and calcium + vitamin D supplements
Proton pump inhibitor- gastric protection with omeprazole

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9
Q

What condition is strongly associated with polymyalgia?

A

Giant cell arteritis

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10
Q

What is GCA?

A

Systemic vasculitis of the medium and large arteries

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11
Q

What patients are at higher risk of GCA?

A

Females over 50

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12
Q

What are the main features of GCA?

A

Severe unilateral headache around temple
Scalp tenderness
Jaw claudication
Blurred or double vision
Sight loss
Systemic symptoms

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13
Q

What is found on temporal artery biopsy?

A

Multinucleated giant cells

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14
Q

What investigations are done for GCA?

A

FBC
LFTs
CRP and ESR- raised
Temporal artery biopsy
Duplex ultrasound of the temporal artery

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15
Q

What is the initial management of GCA?

A

Immediately start steroids (40-60mg prednisolone per day)

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16
Q

Who do you refer a GCA patient to?

A

Vascular surgeon- temporal artery biopsy in all patients
Rheumatology- speciality diagnosis and management
Ophthalmology- complication of vision loss

17
Q

How long can it take to wean patients with polymyalgia/GCA off of steroids?

A

Several years

MSK (20 decks)

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