inflammatory myopathies Flashcards
what are inflammatory myopathies characterised by?
weakness
what is polymyalgia rheumatica characterised by
pain and stiffness
what is fibromyalgia characterised by
pain and fatigue
what is myopathy
disease of the muscle in which the muscle fibres do not function properly
causes weakness
clinical features of polymyositis and dermatomyositis
muscle weakness
- insidious onset, worsening over months
- usually symmetrical, proximal muscles
- often specific problems
what is the skin involvement in dermatomyositis
- Gottron’s sign
- heliotrope rash
- shawl sign
what other organ involvement in dermatomyositis and polymyositis
- ILD
- resp muscle weakness
- dysphagia
- myocarditis
- fever
- weight loss
- Raynauds
- inflammatory arthritis
what malignancy is it associated with
- ovarian
- breast
- stomach
- lung
- bladder
examinations for myositis
-test muscle power (confrontational and isotonic testing)
diagnosis of myositis
blood tests
- raised CK
- CRP
- autoantibodies
- electrolytes, calcium, PTH
electromyography
- increased fibrillations
- abnormal motor potentials
muscle biopsy
MRI
what autoantibody is specific to myositis
Anti-Jo-1
is myositis ANA positive or negative
positive
how is myositis treated
corticosteroids immunosuppression: -azathioprine -methotrexate -ciclosporin if no response: -IV immunoglobin -Rituximab
what is the most definitive diagnostic test for polymyositis
muscle biopsy
age group for polymyalgia rheumatica
over 50
clinical signs of polymyalgia
- ache in shoulder and hip girdle
- morning stiffness
- usually symmetrical
- fatigue, anorexia, weight loss and fever
- reduced movement
- normal muscle strength
what are the key features of temporal arteritis
- headache
- scalp tenderness
- jaw claudication
- visual loss
- tender, enlarged, non-pulsatile temporal arteries
how is temporal arteritis diagnosed
- raised ESR, plasma viscosity, CRP
- temporal artery biopsy or USS
how do you treat polymyalgia rheumatica
start at prednisolone 15mg daily
-gradual reduction in dose over 18 months to 2 years
how is temporal arteritis treated
prednisolone 40-60mg daily
-steroid reduced over 18 months to 2 years
is fibromyalgia inflammatory
no
symptoms of fibromyalgia
muscle pain! fatigue! -headaches -poor sleep pattern -cognitive impairment -anxiety -msk chest pain
criteria for diagnosis of fibromyalgia
- patient experiences widespread pain and associated symptoms
- symptoms have been present at same level for 3 or more months
- no other condition otherwise explains the pain
treatment for fibromyalgia
- education
- graded exercise programme
- CBT
- anti-depressants
- analgesia
- gabapentin and pregabalin
is ILD associated with fibromyalgia
no
