Lower Limb Non-articular Pain

Question 1

What is polymyalgia rheumatica?

Answer 1

Inflammatory disorder, causing inflammation of synovium, bursae, and tendons.

Question 2

Pathophysiology of polymyalgia rheumatica?

Answer 2

1. Idiopathic, believed to be autoimmune
2. Soft tissue inflamed around neck, shoulders, and hips

Question 3

S/S of polymyalgia rheumatica?

Answer 3

1. Diffuse muscle pain, stiffness, and inflammation over shoulder and pelvic girdle
2. > 60 y/o
3. Anaemia
4. Elevated ESR and CRP
5. Reduced range of motion, due to pain

Question 4

What is a red flag for polymyalgia rheumatica?

Answer 4

• Jaw claudification, which indicates that giant cell arteritis is occurring
• in GCA, chronic inflammatory cells infiltrate the arterial walls (es.p carotid artery), leading to granulomatous inflammation > intimal hyperplasia and lumen narrowing > ischaemia
• important to treat before blindness occurs

Question 5

What drugs can cause non-articular pain?

Answer 5

1. Statins
2. Ciclosporin A
3. Penicillamine
4. Clofibrate
5. Ethanol

Question 6

How does hypothyroidism cause arthralgia and myalgia?

Answer 6

1. Decreased TH = decreased metabolism
2. Leads to myopathy and myalgia, as well as accumulation of GAGs in soft tissue (causes non-inflammatory oedematous swelling and stiffness)

Question 7

How does hyperparathyroidism cause soft tissue pain?

Answer 7

1. Increased PTH = increased serum calcium levels
2. Bone pain from resorption
3. Calcification of soft tissues
4. Calcium affects muscle cell excitability, causing myopathy

Question 8

What is a severe form of hyperparathyroid-induced soft tissue pain?

Answer 8

• Osteitis fibrosa cystica
• bone cysts, fibrous tissue replaces bone = pain in surrounding tissue

Question 9

How does hypocortisolism cause soft tissue pain?

Answer 9

1. Decreased metabolism
2. Decreased anti-inflammatory measures

Question 10

How does acromegaly cause soft tissue pain?

Answer 10

1. Increased GH = increased IGF-1 = abnormally-expanded soft tissue leads to pain

Question 11

How does hypermobility syndrome cause soft tissue pain?

Answer 11

• Abnormal flexibility can put a strain on tendons, ligaments, and muscles