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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Myasthenia Gravis: Overview and Treatment01:20

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Myasthenia gravis is a neuromuscular transmission disorder characterized by weakness and increased fatigability of skeletal muscles. It is an autoimmune disease affecting approximately one in 2000 people, where antibodies against the α1 subunit of nicotinic acetylcholine receptors are produced.
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AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
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Myasthenia Gravis ll: Pathophysiology01:22

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The disease process of myasthenia gravis begins at the neuromuscular junction, where antibodies attack key proteins needed for muscle activation. This immune reaction weakens signal transmission, leading to the characteristic muscle fatigue and weakness that define the condition.Immune-Mediated DamageIn most individuals, antibodies target acetylcholine receptors (AChRs) on the postsynaptic membrane of muscle cells. By blocking acetylcholine binding, these antibodies prevent the nerve signal...
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Polymyalgia rheumatica: 125 years of progress?

Patrick J Rooney1, Jennifer Rooney2, Geza Balint3

  • 1Professor of Medicine, Department of Clinical Skills, St George's University, Grenada prooney@sgu.edu.

Scottish Medical Journal
|September 10, 2014
PubMed
Summary

Polymyalgia rheumatica diagnosis and management have seen little progress in 125 years. Clinical acumen remains key, with no objective tests or improved treatments beyond corticosteroids.

Keywords:
MRIPolymyalgia rheumaticagiant cell (temporal) arteritisultrasonography

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Area of Science:

  • Rheumatology
  • Internal Medicine

Background:

  • Polymyalgia rheumatica (PMR) is a distinct clinical condition primarily affecting the elderly.
  • Despite extensive research, diagnostic and therapeutic advancements for PMR have been limited.

Purpose of the Study:

  • To review literature on polymyalgia rheumatica (PMR) to assess clinical care progress over 125 years.
  • To evaluate diagnostic and management advancements in PMR, considering its relationship with giant cell arteritis.

Main Methods:

  • Literature search of Medline and PubMed using terms 'polymyalgia rheumatica', 'giant cell arteritis', and 'temporal arteritis'.
  • Focus on studies treating PMR and giant cell arteritis as separate entities.
  • Selection biased towards PMR as a distinct clinical diagnosis, relying on clinical acumen.

Main Results:

  • Advances in clinical imaging and 60 years of research have minimally improved accurate disease definition for PMR.
  • Clinical management of PMR has seen little change since the introduction of corticosteroids in the 1950s.
  • The relationship between PMR and giant cell arteritis remains unclear.

Conclusions:

  • Polymyalgia rheumatica (PMR) diagnosis remains predominantly clinical, lacking objective laboratory or imaging support.
  • Objective diagnostic methods for PMR are needed to advance understanding of its etiology and optimize treatment.
  • Effective prevention of PMR symptoms while minimizing corticosteroid side effects remains a challenge.