2- muscle diseases

Question 1

what is main characteristic for inflammatory myopathies?

Answer 1

weakness

Question 2

what is main characteristic for polymyalgia rheumatics?

Answer 2

pain & stiffness

Question 3

what is main characteristic of fibromyalgia?

Answer 3

pain & fatigue

Question 4

what is typical presentation of inflammatory myopathies?

Answer 4

it’s idiopathic
- commonly in 40-50 yrs
- muscle weakness over months (a bit of pain but mostly weakness

Question 5

what are 2 types of inflammatory myopathies?

Answer 5

1. dermatomyositis
2. anti-synthetase syndrome

Question 6

what are 3 key rashes distinct for dermatomyositis?

Answer 6

1. gottron’s sign (scaly rash over MCP & PIP)
2. heliotrope rash (scaly around eye)
3. shawl sign (rash over where would drape shwal)

Question 7

what are signs of antisynthetase syndrome?

Answer 7

= very rough skin in people who shouldn’t

• Mechanics hands
• Raynauds
• Myositis
• Interstitial lung disease
• Polyarthritis

Question 8

what major life threatening impacts from muscle weakness?

Answer 8

difficulty swallowing (dysphagia) and difficulty breathing from weakened resp muscles

Question 9

what examinations are done for inflammatory myopathies?

Answer 9

• exam muscles for weakness & wasting
• look any features for malignancy like lymph nodes, abdomen, breast exam, prostate exam (malignancy risk higher in dermatomyositis)
• confrontational test →direct power test
• isotonic test →30 second sit to stand (how many done in 30s)

Question 10

what is used for diagnosis of inflammatory myopathies?

Answer 10

• blood tests →creatinine kinase (CK) goes up by a lot
• inflammatory markers (CRP)
• electrolytes, calcium, thyroid function (to exclude other causes)
• autoantibodies →ANA, anti-jo-1

anti-jo-1 = main one to remember as common. anti-synthetase syndrome

Question 11

what are 3 investigations that can be done for inflammatory myopathies?

Answer 11

1. electromyography (EMG) increased fibrillations, abnormal motor potentials, complex repetitive discharge
2. muscle biopsy (inflammation & necrosis)
3. MRI (inflammation, oedema, fibrosis, calcification)

Question 12

what is treatment for inflammatory myopathy?

Answer 12

1. corticosteroids (lots of side effects)
2. immunosuppression →methotrexate (DMARD), IV immunoglobulin & rituximab (last 2 for more severe)

Question 13

what is polymyalgia rheumatica?

Answer 13

= chronic muscle disease causing pain & stiffness (it’s associated with giant cell arteritis)

Question 14

what is common presentation of polymyalgia rheumatica?

Answer 14

• over 50 yr
• ache in shoulder & hip girdle
• morning stiffness
• usually symmetrical
• fatigue, anorexia, weight loss & fever may occur
• reduced shoulder, neck & hip movement
• muscle strength normal
• temporal/giant cell arteritis diagnosis

Question 15

what are some key features of giant cell arteritis? (type of large vessel vasculitis)

Answer 15

• headache
• scalp tenderness
• jaw claudication (not painful but tiring)
• visal loss
• tender, enlarged, non pulsatile temporal arteries

Question 16

what is treatment for polymyalgia rheumatica?

Answer 16

• give steroids (if also have giant cell arteritis then give higher dose as risk of blindness)
  
  • PMR (polymyalgia rheumatica)= 15mg
  • GCA = 40-60mg
• remember gradual reduction of steroid dose as one for very long time →need to give PPI too and lots of other drugs to help with side effects

Question 17

what is fibromyalgia?

Answer 17

not limited to muscle, pain EVERYWHERE. more in women
- associated with emotional & physical trauma, psychological
= it’s an invisible disease, diagnosis of exclusion!!

Question 18

what is treatment of fibromyalgia?

Answer 18

• patient education
• cognitive behavioural therapy
• complementary medicine like acupuncture or yoga (something to manage pain)

medication→anti-depressants, analgesia (but usually limit)

DIFFICULT →as patients often feel like it’s not real illness since not visible illness, nobody takes them seriously. have to be empathetic with patients