6278969
Descripción
Fichas por Andrew Street, actualizado hace más de 1 año
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Creado por Andrew Street
hace alrededor de 8 años
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| Pregunta | Respuesta |
| PMR & GCA are types of l..... v...... v...... | large vessel vasculitis |
| 1805 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. |
| 1805 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. |
| 1807 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. |
| 1807 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. |
| * 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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