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12 Cards in this Set
- Front
- Back
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PMR
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-inflamm disease of muscles and small arteries occuring almost exclusively in those over 50
-morning stiffness in proximal girdles (shoulder and hip) -sudden onset -inc ESR/CRP |
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OMR epidemiology
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-onset >50 and usually after 60
-highest incidence in N.European extract -F:M ratio 2:1 |
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PMR clinical and lab features
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-pelvic and shoulder girdle aching
-morning stiffness -rapid response to low doses of steroids -anemia -elevated ESr and CRP -occasional elevated alkaline phosphatase |
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Giant cell arteritis features
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1. HA
2. temporal artery abnormality 3. jaw claudication 4. visual loss; diplopia 5. extremity claudication 6. PMR sx 7. wt loss, fever 8. respiratory sx |
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relationship of PMR to GCA
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-40-60% of patients with GCA have PMR symptoms; in about half of these individuals, PMR is their first manifestation of GCA
-10-15% of patients with PMR have GCA -PMR symptoms can occur before, with, or after GCA symptoms in patients with GCA -GCA can develop long after onset and treatment of PMR -Treatment of GCA requires larger doses of corticosteroids than does treatment of PMR |
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ACR criteria of GCA
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-must have at least 3/5 criteria:
1. age >50 2. new HA 3. temporal artery abnormality 4. elevated westergren ESR >50 mm/hr 5. abnml artery bx:mononuclear cell infiltrate, granulomatous inflammation, usually multinucleated giant cells |
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PMR typical presentation
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-75 yo male who present with:
SUDDEN ONSET OF SEVERE AM STIFFNESS IN SHOULDERS AND PELVIC GIRDLE FATIGUE OCCASIONAL FEVER OF 100 HEMOGLOBIN 11.5 DEPRESSION FLU-LIKE ILLNESS PRECEDING ESR 62 |
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PMR labs
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-CBC
-ESr -CRP -RF -TFTs -U/A -chemoscreen -ESr/CRP is primary: HOWEVER, SOME REPORTS INDICATE LOW OR NORMAL ESR IN UP TO 20% |
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conditions assoc with PMR
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1. malignancy
2. APLS 3. hypothyroidism 4. R/O RA |
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tx of PMR
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-bx if HA or systemic sx
-low dose steroids (prednisone) -constant attempts at dosage reduction -assess and treat for op -follow bp, wt, glucose |
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GCA definition
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-Inflammatory disease of
Small arteries characterized by The presence of multinucleate Giant cells on biopsy -HA -blindness!!! |
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tx of GCA
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-60 mgs prednisone immediately upon suspicion and daily thereafter
-call rheumatologist for tx and bx -dont change dose until bx reported -if positive, maintain dose for a month before initiating taper |
