Muscle Disease 11/10/18 Flashcards by K M

What are 7 causes of myopathy?

Inflammatory
Drugs
Infections
Endocrine
Electrolytes
Metabolic
Rhabdomyolitis

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How do muscle diseases present?

Muscle pain
Muscle weakness/tiredness
Stiffness
Abnormal blood tests

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What are three main inflammatory myopathies?

Polymyositis
Dermatomyositis
Inclusion bofy myositis

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Who gets Polymyositis and Dermatomyositis?

1/100000
Females 2x
40-50

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What do Polymyositis and Dermatomyositis increase the risk of?

malignancy

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What is seen on histology of Polymyositis and Dermatomyositis?

Muscle biopsy shows:
Muscle fibre necrosis
Degeneration
Regeneration
Inflammatory cell infilitrate

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What is the cause of Polymyositis and Dermatomyositis?

Not clear

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What are the clinical features of Polymyositis and Dermatomyositis?

Muscle weakness
-insidious onset
Worsening over months
Symmetrical
Myalgia

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What is seen in dermatomyositis?

Cutaneous disease
Gottrons sign
Heliotrope rash
Shawl sign

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What other organs are involved in Polymyositis and Dermatomyositis?

Lungs:
ILD
Respiratory muscle weakness
Oesophagus:
Dysphagia
Cardiac:
Myocarditis
Other:
Fever
Weight loss
Raynauds

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What is the incidence of malignancy in Polymyositis and Dermatomyositis?

P - 9%

D - 15%

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What kind of malignancy is seen in Polymyositis and Dermatomyositis?

Ovarian
Breast
Stomach
Lung
Bladder
Colon

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Who has the greatest malignancy risk with Polymyositis and Dermatomyositis?

Men >45

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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

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What are two examinations for Polymyositis and Dermatomyositis?

Confrontational testing
-DIrect power test
Isotonic testing
-30 second sit to stand test

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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?

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 ```