Lower Limb Non-articular Pain Flashcards
1
Q
What is polymyalgia rheumatica?
A
Inflammatory disorder, causing inflammation of synovium, bursae, and tendons.
2
Q
Pathophysiology of polymyalgia rheumatica?
A
- Idiopathic, believed to be autoimmune
- Soft tissue inflamed around neck, shoulders, and hips
3
Q
S/S of polymyalgia rheumatica?
A
- Diffuse muscle pain, stiffness, and inflammation over shoulder and pelvic girdle
- > 60 y/o
- Anaemia
- Elevated ESR and CRP
- Reduced range of motion, due to pain
4
Q
What is a red flag for polymyalgia rheumatica?
A
- 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
5
Q
What drugs can cause non-articular pain?
A
- Statins
- Ciclosporin A
- Penicillamine
- Clofibrate
- Ethanol
6
Q
How does hypothyroidism cause arthralgia and myalgia?
A
- Decreased TH = decreased metabolism
- Leads to myopathy and myalgia, as well as accumulation of GAGs in soft tissue (causes non-inflammatory oedematous swelling and stiffness)
7
Q
How does hyperparathyroidism cause soft tissue pain?
A
- Increased PTH = increased serum calcium levels
- Bone pain from resorption
- Calcification of soft tissues
- Calcium affects muscle cell excitability, causing myopathy
8
Q
What is a severe form of hyperparathyroid-induced soft tissue pain?
A
- Osteitis fibrosa cystica
- bone cysts, fibrous tissue replaces bone = pain in surrounding tissue
9
Q
How does hypocortisolism cause soft tissue pain?
A
- Decreased metabolism
- Decreased anti-inflammatory measures
10
Q
How does acromegaly cause soft tissue pain?
A
- Increased GH = increased IGF-1 = abnormally-expanded soft tissue leads to pain
11
Q
How does hypermobility syndrome cause soft tissue pain?
A
- Abnormal flexibility can put a strain on tendons, ligaments, and muscles
