3060102
Description
Flashcards by esther.westwood, updated more than 1 year ago
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Created by esther.westwood
almost 9 years ago
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| Question | Answer |
| What percentage of >65 year olds have PMR? | 3% |
| A) What percentage of PMR patients get TA? B) What percentage of TA patients get PMR? | A) 15-30% B) 50% |
| What is the pathophysiology of PMR? | Mild, non-erosive synovial and peri-articular inflammation of proximal joints Some patients: sub-clinical vasculitis |
| What is the pathophysiology of TA? | Granulomatous vasculitis As a result of accumulation of inflammatory infiltrate in medium and large arteries Causes vessel wall injury, luminar occlusion and vascular stenosis = ischaemia |
| What are the diagnostic criteria for PMR? | >50yo Duration >2 weeks Bilateral pelvic and/or shoulder girdle ache Morning stiffness lasting >45 minutes Evidence of an acute phase response (ESR/CRP/ALP) And don't forget to assess for TA! |
| What are some differentials for proximal girdle pain? | Rheumatoid arthritis Late onset spondyloarthritis Connective tissue disease (SLE) CPPD (Pseudogout) Muscle disease: myositis, dermatomyositis, polymyositis MSK problem: bursitis, tendinitis Cervical spondylosis Neoplasm: myeloma, leukaemia, paraneoplastic syndrome Endocrine: Hypothyroidism, hypercalcaemia, hyperparathyroidism, T2DM Atypical presentation of Parkinson's Osteomalacia Infection: flu; septic arthritis/osteomyelitis; TB Fibromyalgia syndrome |
| SIDEBAR: Which drugs especially can cause myositis? | Statins |
| What investigations should be done in proximal girdle pain? | Bloods: ESR/CRP, FBC, U+E, glucose, calcium (PTH if abnormal), TFTs, ANA, RF, anti-CCP, CK Chest x-ray Urine dip |
| What results would you expect from investigating PMR? | Raised ESR/CRP Normochromic/normocytic anaemia (anaemia of chronic disease) Platelets may be raised RF, ANA and anti-CCP would all be negative |
| Which imaging investigations would be useful in suspected PMR? | MRI Ultrasound To show peri-articular inflammation |
| What is the management of PMR? | 15mg prednisolone for 2 weeks (patients should report a 70% improvement; refer to specialist if patient is <60, there are red flags, there is no response to steroid, it is an atypical presentation etc) |
| What is the initial dose of prednisolone for PMR and what is the regime for reducing it to a maintenance dose? | 10-20mg for 1 month Reduce to 10mg by 2.5mg every 2-4 weeks Reduce by 1mg every 4-6 weeks (or until symptoms return) |
| What is the maintenance dose of prednisolone for PMR most people get stuck at and what is the regime for withdrawal? | 5-7mg/day for 6 months Final reduction by 1mg every 6-8 weeks |
| How long is the treatment course for PMR? | 2 years (But a lot of people take 3) |
| Which drugs can be used as steroid-sparing agents in PMR? | Methotrexate Azathioprine |
| What are the symptoms of temporal arteritis? | (Unilateral, constant) Headache Scalp tenderness Altered vision (15%) Jaw or tongue claudication (50%) Nodular swellings Poor pulsation RARE = scalp necrosis, cranial nerve palsy, limb claudication, systemic signs or symptoms |
| How is TA picked up? | History and examination - palpate the temporal arteries Bloods: raised ESR/CRP raised platelets and WCC anaemia ? raised ALP Temporal artery biopsy is the gold standard diagnostic tool. (50% false negative rate due to skip lesions) |
| What lesion is characteristic of TA on US? | Halo sign |
| What is the management of TA A) without visual symptoms B) with visual symptoms? | A) Prednisolone 20-40mg daily for 8 weeks. Reduce by 5mg every 3-4 weeks At 10mg, treat as PMR B) Prednisolone 40-80mg daily for 8 weeks. Reduce to 20mg daily over 4 weeks. Treat as uncomplicated TA |
| A) How long are steroids weaned in TA? B) What is the threshold for using steroid-sparing drugs? | A) 1 year-18 months B) Low |
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