#61 Vasculitis and Giant-Cell Arteritis: ‘Rheum’ for improvement

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 Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at [email protected]. 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