Flashcards
Musculoskeletal: Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA)
Cards in this deck (6)
- 1PMR & GCA are types of l..... v...... v......large vessel vasculitis
- 21805 Clinical features of PMR.* Sudden onset of +++P & stiffness in shoulders, neck, hips, lumbar spine ('limb girdle pattern'). Sx +++ in AM - may last several hours.
* Pt is usually >50 YO
* 1/3 of pt's have systemic Sx - tiredness, fever, weight loss, depression.
K & C p542. - 31805 Clinical features of GCA.* Generally occurs in >50 YO & alongside PMR
* Severe HA
* Tenderness of scalp or temple
* Claudication of the jaw when eating
* Tenderness & swelling in one or more temporal or occipital arteries
* Sudden, painless, loss of vision in one eye.
K & C p543. - 41807 Ix of PMR.* ^ ESR and/or CRP is a hallmark of this condition. It is rare to see PMR without an acute-phase response.
* Serum alkaline phosphatase and γ-glutamyl-transpeptidase may be raised as markers of the acute inflammation.
* Anaemia (mild normochromic, normocytic) is often present.
* Temporal artery biopsy shows giant cell arteritis in 10–30% of cases, but is rarely performed unless GCA is also suspected.
K & C p543. - 51807 Ix of GCA.* Normochromic, normocytic anaemia
* ^ ESR (in the region of 50–120 mm/h) and the CRP very high
* Liver biochemistry. Abnormalities occur, as in PMR. The albumin may be low
* A temporal artery biopsy from the affected side is the definitive diagnostic test. This should be taken before, or within 7 days of starting, high doses of corticosteroids. The lesions are patchy and the whole length of the biopsy (>1 cm long) must be examined; even so, negative biopsies occur.
K & C p543. - 6* Outline the management of PMR/GCA and the potential long term complications of Rx.* Corticosteroids - should produce a dramatic reduction of Sx. If not seek alternative Dx. Doses ^ in GCA than PMR. If GCA is suspected start Rx immediately to avoid loss of sight. Prednisalone is usually used - tapered over 18/12. Calcium & vit D, & sometimes bisphosphonates, are needed to prevent osteoporosis.
K & C p543.
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- SGUL LOBs for Musculoskeletal: Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA).
- Created by
- Andrew Street · Sep 2016
- Updated
- Nov 1, 2016
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