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MSK Week 2 2017/18 > 7: Muscle disease > Flashcards

7: Muscle disease Flashcards

1
Q

What does myopathy mean?

A

Any pathology involving muscle

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2
Q

What are some symptoms of muscle disease?

A

Myalgia (muscle pain)

Muscle weakness (often described as tired, heavy)

Stiffness

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3
Q

What is the generic name for inflammatory muscle disease?

A

Myositis

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4
Q

What are two idiopathic inflammatory myopathies?

A

Polymyositis

Dermatomyositis (+ skin)

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5
Q

Myositis is more common in (men / women).

A

women

as with all autoimmune disease

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6
Q

People with myositis are at increased risk of ___.

A

malignancy

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7
Q

What can be seen under the microscope in someone with myositis?

A

Necrosis

Regeneration

Inflammatory cell infiltrate

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8
Q

Which muscles are commonly affected by myositis?

A

Shoulder muscles

Hip muscles

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9
Q

What is the main symptom of myositis?

A

Muscle weakness

i.e difficulty performing everyday tasks

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10
Q

Myositis has an (acute / insidious) onset.

A

insidious

over a period of months

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11
Q

Is myositis symmetrical or asymmetrical?

A

Symmetrical

(Inclusion body myositis can be asymmetrical)

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12
Q

What are typical skin features of dermatomyositis?

A

Gottron’s papules - violet patches over PIP and MCP joints

Heliotrope rash - characteristic rash around eyes

Shawl sign - rash on back, as if patient has been wrapped up in a blanket (made of acid???)

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13
Q

10% of myositis patients also have lung disease - which type?

A

Interstitial lung disease

pulmonary fibrosis

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14
Q

What is a GI symptom associated with myositis?

A

Dysphagia

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15
Q

Which type of cardiac muscle may be affected by myositis?

What is this condition called?

A

Myocardium

Myocarditis

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16
Q

People with muscle disease may have apparent (hypertrophy / atrophy).

A

atrophy

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17
Q

What is confrontational testing?

A

Patient attempts to resist your power, gives an indication of muscle strength

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18
Q

What is isotonic testing?

A

Gives indication of muscle stamina

e.g 30s sit to stand test

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19
Q

What are some blood tests which can be carried out to identify muscle disease?

A

Creatine kinase - released when muscles break down, first-line test

Inflammatory markers - CRP and ESR will be raised in inflammatory myopathies

U&Es - for other causes e.g hypocalcaemia, hyperkalaemia

Autoantibody tests - for anti Jo-1 antibody in particular

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20
Q

Which non-specific autoantibody may be raised in inflammatory myositis?

A

ANA

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21
Q

What is a specific autoantibody for inflammatory myositis?

A

Anti-Jo-1

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22
Q

Which test involves putting two needles into muscle and passing a current through them to track action potentials?

A

Electromyography (EMG)

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23
Q

What is the definitive test to diagnose inflammatory myositis?

A

Muscle biopsy - loads of signs of inflammation

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24
Q

How is inflammatory myositis treated?

A

Steroids

Immunosuppressants as steroid-sparers: azathioprine, methotrexate, ciclosporin

be aware that methotrexate causes pneumonitis

Biologic agents

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25
Why are steroids started **before** immunosuppressants despite the fact that they may cause muscle pain as a side effect?
**Immunosuppressants take 4-6 weeks to start working**
26
Apart from steroids and immunosuppressants, what else may be given to patients with severe inflammatory myositis?
**IV immunoglobulin** **Rituximab** (inhibit B cells) but expensive and lots of side effects so be careful
27
(Poly)myositis and dermatomyositis are examples of ___ diseases.
**autoimmune**
28
Polymyositis and dermatomyositis affect **(proximal / distal)** muscles.
**proximal**
29
Which myositis is **more common** **in men**, **affects distal muscles** and is often misdiagnosed as polymyositis?
**Inclusion body myositis**
30
If you're treating a patient for inflammatory myositis and they aren't responding to treatment, what should be considered?
**Inclusion body myositis**
31
Is inclusion body myositis an autoimmune disease?
**No**
32
Which class of drug may cause symptoms similar to myositis?
**Statins**
33
Are polymyositis and polymyalgia the same thing?
**Noooo**
34
Do people under the age of 50 get polymyalgia rheumatica?
**No**
35
Which type of vasculitis is **polymyalgia rheumatica** associated with?
**Giant cell arteritis**
36
Which muscles are affected by **polymyalgia rheumatica**?
**Proximals** - shoulders, hips
37
Do people with polymyalgia rheumatica have muscle **weakness**?
**No**
38
What are the symptoms of polymyalgia rheumatica?
**Muscle PAIN** **Muscle STIFFNESS**
39
Polymyalgia rheumatica has a **(rapid / insidious)** onset.
**rapid onset** - weeks
40
People with polymyalgia rheumatica often feel quite unwell systemically - what symptoms may they have?
**Fatigue** **Anorexia** **Weight loss** **Fever**
41
What does a muscle biopsy of someone with polymyalgia rheumatica look like?
**Normal**
42
What is vasculitis?
**Inflammation of endothelium**
43
Which artery is affected by giant cell arteritis? Which nerve does it supply?
**Temporal artery** **Optic nerve**
44
Which symptoms are associated with giant cell arteritis?
**Pain, tenderness** in the temporal region ## Footnote **Achey scalp** **Jaw claudication**
45
Why do people with giant cell arteritis get jaw claudication?
**Increased oxygen demand of mastication muscles** but vasculitis reduces blood flow
46
People with giant cell arteritis often experience visual \_\_\_.
**loss**
47
Why must visual loss associated with giant cell arteritis be treated seriously?
**Permanent blindness may result**
48
In giant cell arteritis, the temporal arteries may become **\_\_\_** and **(palpable / unpalpable)**.
**unpalpable**
49
How is polymyalgia rheumatica diagnosed?
**Can only be diagnosed clinically** **+/- Raised inflammatory markers** **+/- Apparent giant cell arteritis**
50
How is polymyalgia rheumatica treated?
**Steroids**
51
How long does polymyalgia rheumatica tend to last?
**18-20 months**
52
The steroid dose for polymyalgia rheumatica is gradually **(increased / reduced)****.**
**reduced**
53
Polymyalgia rheumatica shows a ___ response to steroids.
**dramatic**
54
What is a very common **non-inflammatory** myopathy?
**Fibromyalgia**
55
What is the prevalence of fibromyalgia?
**2-5%**
56
Fibromyalgia is more common in **(men / women)**.
**women**
57
What may trigger fibromyalgia?
**Emotional or physical stress**
58
Fibromyalgia is sort of cyclical because it is associated with a lot of other illness. What are some examples?
**Depression** **IBS** leading to poor sleep patterns and stress, fibromyalgia...
59
What are the symptoms of fibromyalgia?
**Myalgia** - particularly neck, shoulders, hips **Pins and needles** **Headaches** **"Brain fog"** - poor concentration and memory
60
How do fibromyalgia patients describe their pain?
**Diffuse** **Exacerbated by exertion, fatigue, stress**
61
Fibromyalgia often ___ sleep.
**disturbs** described as 'unrefreshing'
62
Similar to polymyalgia rheumatica, how is fibromyalgia diagnosed?
**Literally by excluding everything else** All tests are normal but should be done to exclude inflammation, muscle damage
63
How is fibromyalgia treated?
**Medications** - analgesia (inc. atyptical antidepressants like amitryptiline) -- val medication??? Behavioural therapy Complementary therapy
64
What happens to nociceptors in fibromyalgia?
**Hypersensitive**
65
Why do some people treat fibromyalgia as a made-up disease?
**No reason for pain receptors to react the way they do**
66
Is medication effective in fibromyalgia?
**Tends not to be**
67
What kind of exercise programme may people with fibromyalgia try?
**Graded** increasing amounts of light exercise
68
Is there any organ pathology in fibromyalgia?
**No**
69
What questions should be asked to someone with suspected polymyalgia rheumatica?
**Better/worse on exercise?** **Headaches, vision problems?**
70
What examinations should be performed on someone with suspected polymyalgia rheumatica?
**Test muscle power - should be normal** **Examine and palpate temporal arteries**
71
What tests should be performed for suspected polymyalgia rheumatica?
**Blood test** - inflam markers, CK etc.
72
What dose of prednisolone should be given to a patient with suspected polymyalgia rheumatica?
**15mg** they'll come back and call it a miracle cure
73
What are some side effects of steroids which should be considered before putting patients on them?
**Weight gain** **Osteoporosis** (give vit d and calcium supplements, biphosphonates)

MSK Week 2 2017/18 (11 decks)

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