Keep your cool in the face of inflammation, and make the path to vasculitis diagnosis less tortuous with Dr. Rebecca Sharim, Rheumatologist and Assistant Professor of Medicine at Temple University. In this episode, we go with the flow from large vessel to small vessel vasculitides, and then learn how to make the diagnosis and management of Giant Cell Arteritis (GCA) and polymyalgia rheumatica (PMR) less of a headache. Correspondent, Dr. Bryan Brown cohosts!
Special thanks to Dr. Bryan Brown for writing our show notes, and creating figures for our handouts.
Full show notes available at http://thecurbsiders.com/podcast
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Case from Kashlak Memorial: A 75 year-old woman with a PMHx of hypertension presents to the ED with three days of worsening left sided headache, now with left sided vision loss during a Norwegian folk festival. On review of systems, she also endorses a week of soreness of her shoulders and hips. This has never happened to her before.
Time Stamps
00:00 Intro
03:07 Picks of the week
09:13 Getting to know our guest
15:00 Clinical case of vasculitis
15:59 Defining and classifying vasculitis
20:55 Workup for suspected vasculitis
23:17 How to explain GCA to a patient
25:08 Typical symptoms of vasculitis
28:00 Chewing gum test
29:34 Interpreting ESR
32:54 Basic exam and lab workup for vasculitis
35:23 Headache and suspicion for GCA/temporal arteritis
38:10 Is a temporal artery biopsy still mandatory?
39:20 Polymyalgia rheumatica
40:59 Steps to take when GCA/temporal arteritis suspected in clinic
43:55 PCP prophylaxis with high dose steroids
46:30 DMARDs and steroid sparing agents
48:12 Imaging studies to aid in diagnosis of GCA
50:50 Complications of long term steroid therapy
52:31 Take home points
53:26 Outro
Tags: giant, cell, arteritis, gca, vasculitis, steroids, temporal, biopsy, artery, esr, pmr, polymyalgia, rheumatica, vessel, headache, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, practitioner, professional, primary, physician, resident, student
The Curbsiders Internal Medicine Podcast