NR 603 Week 7 (Polymyalgia Rheumatica and Giant Cell Arteritis) Questions with Correct
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giant cell arteritis aka temporal arteritis
giant cell arteritis temporal artery granulomatous vasculitis, can cause ipsilateral blindness
(ophthalmic artery)
polymyalgia rheumatica geriatric inflammatory disorder of the muscles and joints
characterized by pain and stiffness in the neck, shoulders, upper arms, and hips and thighs
giant cell arteritis •Dg should be considered in pt > 50 years with:
•New headaches
•Abrupt onset of visual disturbances, especially transient monocular visual loss
•Jaw claudication
•Unexplained fever, anemia, or other constitutional symptoms and signs
•High ESR and/or CRP
•Current or prior PMR
giant cell arteritis MC vasculitis
thickened and nodular temporal arteries
ischemic optic neuropathy (swollen optic disc with blurred margins)
symptoms: anorexia or weight loss, night sweats, weakness, depression What is seen on PE
with GCA?
giant cell arteritis MC rheumatic cause of fever of unknown origin in elderly
, ESR > 100
mild to moderate anemia
increased platelets What is seen with labs in GCA?
•Age >/= 50 at time of onset
•Localized headache of new onset
•Tenderness or decreased TA pulse
•ESR > 50 mm/hour
•Positive TA biopsy with necrotizing arteritis & mononuclear cells or a granulomatous process
with multinucleated giant cells ACR criteria for CGA
prednisone
do not delay tx
temporal artery biopsy within 2-4 weeks
steroid sparing med: Tocilizumab
®Prednisone start 1 mg/kg/day (typically 60mg/day)
®Methyprednisolone 1000 mg IV for visual loss prevention
®Prednisone should be tapered slowly over 1-2 years (minimum)
®Relapses common 1-2 years after diagnosis 1st line tx of GCA
Tocilizumab MOA: IL-6 receptor antagonist
polymyalgia rheumatica Age greater than 50 years
Pain and stiffness > 4 weeks duration in muscles of the neck , shoulder girdle, and pelvic girdle-
symmetric fashion
Dramatic clinical response to small doses of prednisone
Answers| Latest Update Guaranteed Success
giant cell arteritis aka temporal arteritis
giant cell arteritis temporal artery granulomatous vasculitis, can cause ipsilateral blindness
(ophthalmic artery)
polymyalgia rheumatica geriatric inflammatory disorder of the muscles and joints
characterized by pain and stiffness in the neck, shoulders, upper arms, and hips and thighs
giant cell arteritis •Dg should be considered in pt > 50 years with:
•New headaches
•Abrupt onset of visual disturbances, especially transient monocular visual loss
•Jaw claudication
•Unexplained fever, anemia, or other constitutional symptoms and signs
•High ESR and/or CRP
•Current or prior PMR
giant cell arteritis MC vasculitis
thickened and nodular temporal arteries
ischemic optic neuropathy (swollen optic disc with blurred margins)
symptoms: anorexia or weight loss, night sweats, weakness, depression What is seen on PE
with GCA?
giant cell arteritis MC rheumatic cause of fever of unknown origin in elderly
, ESR > 100
mild to moderate anemia
increased platelets What is seen with labs in GCA?
•Age >/= 50 at time of onset
•Localized headache of new onset
•Tenderness or decreased TA pulse
•ESR > 50 mm/hour
•Positive TA biopsy with necrotizing arteritis & mononuclear cells or a granulomatous process
with multinucleated giant cells ACR criteria for CGA
prednisone
do not delay tx
temporal artery biopsy within 2-4 weeks
steroid sparing med: Tocilizumab
®Prednisone start 1 mg/kg/day (typically 60mg/day)
®Methyprednisolone 1000 mg IV for visual loss prevention
®Prednisone should be tapered slowly over 1-2 years (minimum)
®Relapses common 1-2 years after diagnosis 1st line tx of GCA
Tocilizumab MOA: IL-6 receptor antagonist
polymyalgia rheumatica Age greater than 50 years
Pain and stiffness > 4 weeks duration in muscles of the neck , shoulder girdle, and pelvic girdle-
symmetric fashion
Dramatic clinical response to small doses of prednisone
