Polymyalgia & Giant cell INFO

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Posted by a from IP 4.249.3.38 on July 01, 2013 at 06:57:10:

Polymyalgia rheumatica (PMR) and giant cell arteritis form a spectrum of disease and affect patients of
>50 years of age; up to 15% of patients with PMR have giant cell arteritis and 40% of patients with active
giant cell arteritis have symptoms of PMR.

Polymyalgia Rheumatica
Clinical features.
Pain and stiffness in the neck, shoulder, and pelvic girdle. Symptoms are bilateral and symmetric and
more prolonged in the morning. May have diffuse aching.
Systemic features such as low-grade fever, fatigue, and weight loss.
ESR and C-reactive protein are elevated with ESR elevation of 50 to 100 mm common. However, 15% of
those with PMR may have a normal sedimentation rate.
Diagnosis.
Rule out other causes such as claudication, hypothyroidism, myositis. In PMR thyroid functions are
normal, CPK and aldolase are not elevated, ANA should be "normal" for age, and rheumatoid factor will
be negative. Patients may have normocytic, normochromic anemia.
Giant cell arteritis should be excluded.

Treatment
Prednisone. Initial dose of 10 to 20 mg PO QD for 1 month and then reduce by 2.5 mg every 2 to 4
weeks until the dose is 10 mg. The maintenance dose is about 10 mg PO QD and may be decreased to a
range of 5 to 7.5 mg PO QD after 6 months. Most patients require treatment for 3 to 4 years, but
withdrawal after 2 years is worth attempting.

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Giant Cell Arteritis (Temporal Arteritis)
Clinical features.
Predominantly affects persons >50 years of age with early symptoms of headache, fever, fatigue, and
perhaps upper-limb girdle pain. May have associated ocular symptoms including partial visual loss and
field cuts, diplopia, ptosis, and blindness. Tongue or jaw claudication may occur.
Laboratory abnormalities. Greatly elevated ESR, but 10% may have normal ESR, moderate normochromic
anemia, and thrombocytosis.
Diagnosis. Temporal artery biopsy is most useful within 24 hours of starting treatment; however,
steroids have little effect on the sensitivity of the biopsy, and treatment should not be delayed. A
positive result helps to prevent later doubt about the diagnosis. Sensitivity of a biopsy is determined by
length of artery taken and thinness of sections on microscopy.

Treatment. Prednisone: initial dose of 20 to 40 mg PO QD for 8 weeks. Patients with ocular symptoms
may need up to 80 mg PO QD. Reduce the dose by 5 mg every 3 to 4 weeks until it is 10 mg QD and
then taper slowly. The maintenance dose is about 3 mg PO QD.

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