Page 1313 - TNFlipTest

Toronto Notes 2019 Non-Articular Rheumatism Non-Articular Rheumatism
Definition
• disordersthatprimarilyaffectsofttissuesorperiarticularstructures • includesbursitis,tendinitis,tenosynovitis,fibromyalgia,andPMR
Polymyalgia Rheumatica
Definition
• characterizedbypainandstiffnessoftheproximalextremities(girdlearea) • closelyrelatedtoGCA(15%ofpatientswithPMRdevelopGCA)
• nomuscleweakness
Rheumatology RH27
Table 31. PMR Classification Criteria Scoring Algorithm*
Morning stiffness duration >45 min
Hip pain or limited ROM
Absence of RF or ACPA
Absence of other joint involvement
At least one shoulder with subdeltoid and/or biceps tenosynovitis and/or glenohumeral synovitis (either posterior or axillary) and at least one hip with synovitis and/or trochanteric bursitis on U/S
Both shoulders with subdeltoid bursitis, biceps tenosynovitis, or gleno-humeral synovitis on U/S
Points without U/S (0-6)
2
1
2
1 N/A
N/A
Points with Abnormal U/S** (0-8)
2 1 2 1 1
1
*Required criteria: age ≥50 yr, bilateral shoulder aching, and abnormal ESR/CRP
**A score of 4 or more is categorized as PMR in the algorithm without U/S and a score of 5 or more is categorized as PMR in the algorithm with U/S **Optional U/S criteria
Ann Rheum Dis 2012;71:484-492
Epidemiology
• incidence50per100,000peryearinthose>50yr • ageofonsettypically>50yr,F:M=2:1
Signs and Symptoms
• constitutionalsymptomsprominent(fever,weightloss,malaise)
• painandstiffnessofsymmetricalproximalmuscles(neck,shoulderandhipgirdles,thighs) • gelphenomenon(stiffnessafterprolongedinactivity)
• physicalexamrevealstendermuscles,butnotrueweaknessoratrophy
Investigations
• bloodwork:oftenshowsanemiaofchronicdisease,elevatedplatelets,elevatedESRandCRP,and normal CK; up to 5% of PMR reported with normal inflammatory markers
Treatment
• goaloftherapy:symptomrelief
• startwithprednisonedoseof15-20mgPOOD,reconsiderdiagnosisifnoresponsewithinseveraldays • taperslowlyover1yrperiodwithcloselymonitoring
• relapsesshouldbediagnosedandtreatedonclinicalbasis;donottreatariseinESRasarelapse
• treatrelapsesaggressively(50%relapserate)
• monitorforsteroidsideeffects,glucocorticoid-inducedosteoporosisprevention,andfollowfor
symptoms of GCA