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The Curbsiders Internal Medicine Podcast


Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Oct 9, 2017

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

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