Muscle Disease 11/10/18 Flashcards
What are 7 causes of myopathy?
Inflammatory Drugs Infections Endocrine Electrolytes Metabolic Rhabdomyolitis
How do muscle diseases present?
Muscle pain
Muscle weakness/tiredness
Stiffness
Abnormal blood tests
What are three main inflammatory myopathies?
Polymyositis
Dermatomyositis
Inclusion bofy myositis
Who gets Polymyositis and Dermatomyositis?
1/100000
Females 2x
40-50
What do Polymyositis and Dermatomyositis increase the risk of?
malignancy
What is seen on histology of Polymyositis and Dermatomyositis?
Muscle biopsy shows: Muscle fibre necrosis Degeneration Regeneration Inflammatory cell infilitrate
What is the cause of Polymyositis and Dermatomyositis?
Not clear
What are the clinical features of Polymyositis and Dermatomyositis?
Muscle weakness -insidious onset Worsening over months Symmetrical Myalgia
What is seen in dermatomyositis?
Cutaneous disease
Gottrons sign
Heliotrope rash
Shawl sign
What other organs are involved in Polymyositis and Dermatomyositis?
Lungs: ILD Respiratory muscle weakness Oesophagus: Dysphagia Cardiac: Myocarditis Other: Fever Weight loss Raynauds
What is the incidence of malignancy in Polymyositis and Dermatomyositis?
P - 9%
D - 15%
What kind of malignancy is seen in Polymyositis and Dermatomyositis?
Ovarian Breast Stomach Lung Bladder Colon
Who has the greatest malignancy risk with Polymyositis and Dermatomyositis?
Men >45
How are Polymyositis and Dermatomyositis diagnosed?
Presenting symptoms -tired muscles -functional difficulty -Muscle pain DM Thyroid disease Steriods Statins Family history Alcohol Illicit drug use Weight loss cough Breathlessness
What are two examinations for Polymyositis and Dermatomyositis?
Confrontational testing
-DIrect power test
Isotonic testing
-30 second sit to stand test
What would blood tests show on Polymyositis and Dermatomyositis?
Muscle enzymes CK Inflammatory markers Electrolytes Calcium PTH TSH Auto-antibodies Anti-Jo
What is seen on EMG with Polymyositis and Dermatomyositis?
Increased fibrillations
Abnormal motor potentials
Complex repetitive discharges
What is seen on muscle biopsy with Polymyositis and Dermatomyositis?
Perivascular inflammation and muscle necrosis
What is seen on MRI with Polymyositis and Dermatomyositis?
Muscle inflammation
Oedema
FIbrosis
Calcification
What are the treatments for Polymyositis and Dermatomyositis?
Glucocorticoids Azathioprine Methotrexate Ciclosporin IV immunoglobulin Rituximab
Who gets Polymyalgia rheumatica?
> 50s
1% of people
Associated with TA/GCA
What are the clinical signs of Polymyalgia rheumatica?
Ache in shoulder and hip Morning stiffness Fatigue Anorexia Weight loss Fever Reduced shoulder movement Normal muscle strength
What are the symptoms of TA/GCA?
Granulomatous arteritis of large vessels Headache Scalp tenderness Jaw claudication Visual loss Tender, enlarged, non pulsatile temporal arteroes
How are TA/GCA diagnosed?
Exclude other diagnosis Raised ESR Plasma viscosity CRP Temporal artery biopsy
What is the treatment for TA/GCA?
Rapid and dramatic response to low dose steroids
Higher dose in TA
Gradual reduction in dose over 2 years
What is the commonest cause of chronic MSK pain?
Fibromyalgia
Is Fibromyalgia associated with inflammation?
No
Who gets Fibromyalgia?
Women
22-50
When may Fibromyalgia begin?
After emotional of physical trauma
What is the fibromyalgia cycle?
Pain Muscle tension Daily stress Limited activity Fatigue Depression Muscle stiffness Pain Etc
What are some symptoms associated with Fibromyalgia?
Tension migrane TMJ disorder Oesophageal dysmotilitiy IBS Weight loss Night sweats Weakness Sleep disturbance Cognitive issues ENT problems Vestibular complaints Allergic symtpons Hypotension Chest pain
What are the clinical manifestations of Fibromyalgia?
Pain neck, shoulders, lower back, chest wall
Diffuse and chronic
Varies in intensity
Symptoms worse with exertion, fatigue and stress
Sensation of swelling
Fatigue and poor, unrefreshing sleep
Pins and needles/tingling, headaches, depression, abdominal pain (IBS), poor concentration and memory
What are the clinical findings of Fibromyalgia?
Excessive tenderness on palpation of soft tissues
11/18 tender points
No other abnormality of MSK
According to the ACR criteria, when can Fibromyalgia be diagnosed?
Patient experiences widespread pain and associated symptoms
(Unrefreshed sleep, cognitive symptoms, fatigue)
>3 moths
No other explanatory condition
What is the treatment of Fibromyalgia?
Education MDT Exercise programme CBT Complimentary medicine ANti-depressants Analgesia
