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

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.8 • 3.1K Ratings

🗓️ 9 October 2017

⏱️ 55 minutes

🔗️ Recording | iTunes | RSS

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Summary

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

Transcript

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0:00.0	So this is the most boring part of the show where I'm just gonna give everybody a couple ground rules just to try to make sure we get good audio
0:07.0	This is my favorite part. Yeah, this is so and this actually this is mostly ironically for Stewart who is my longest running co-host most of these rules are
0:18.1	I broke open every one of every time
0:30.0	Welcome back to the curbsiders. Hello, Matt. Hello, Stewart. This is the internal medicine pod that uses expert interviews to bring you clinical pearls and practice changing knowledge
0:46.6	I've now got multiple people interrupting this great. I'm Dr. Matthew Wato here with multiple co-hosts and
0:54.3	Let's introduce them. Dr. Stuart can't bring them. That's me
0:58.8	Dr. Dr. Paul Williams
1:01.0	Hi, Matt. Hi, Stewart and
1:03.7	And we got we have one of our correspondence Dr. Brian Brown. Hi, Brian. Hey guys, have it to be here. I am not impressed with his musical talents
1:13.0	What what is that about?
1:16.4	Give me a chance
1:18.6	Yeah, he's actually quite talented. Yeah, Brian. Why don't you want to give the audience a one-liner about yourself so they can get to know you
1:25.9	All right, so I am a
1:28.3	28-year-old internal medicine resident with a past history of mandolin playing and science fiction writing
1:34.5	presenting with interests and primary care
1:37.1	Education
1:39.1	And talking about science and medicine with whomever will listen
1:46.1	I think Stewart yeah, yeah, Stewart sorry that Stewart interrupted you but Brian
1:52.4	Brian has much more much more experience in sound and video than we do and he could sing which is so we'll link to his YouTube
2:01.1	In some of his YouTube stuff you should check it out
2:04.2	Yeah, you might get like five views now from from all of our listeners
2:09.4	It isn't his on his YouTube pages as unsigned
	...

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